Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Urology
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR)
(919) 350-6089
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7251
(919) 350-1606
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0554
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
05/14/2014
Last updated
09/12/2016
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