Organization
WAKE DERMATOLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADNAN NASIR M.D. (PHYSICIAN, OWNER)
(919) 781-1001
Entity
Organization
Contact information
Practice address
4414 LAKE BOONE TRL, STE 408, RALEIGH, NC 27607-7513
(919) 781-1001
(919) 781-3909
Mailing address
4414 LAKE BOONE TRL, STE 408, RALEIGH, NC 27607-7513
(919) 781-1001
(919) 781-3909
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
40537
NC
207NS0135X
Procedural Dermatology Physician
40537
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02261
BLUE CROSS GROUP NUMBER
NC
01
—
2344640
MEDICARE GROUP NUMBER
—
Enumeration date
12/11/2006
Last updated
04/04/2011
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