Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WPP Wake Ortho
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
8001 T W ALEXANDER DR, SUITE 224, RALEIGH, NC 27617-8768
(919) 232-5020
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0554
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
01
—
7108950002
DME PTAN
NC
Enumeration date
07/11/2014
Last updated
10/16/2017
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