Organization
WAKE SPINE & PAIN SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADETTE MAUCERI (OFFICE MANAGER)
(919) 787-7246
Entity
Organization
Contact information
Practice address
115 KILDAIRE PARK DRIVE, SUITE 205, CARY, NC 27518
(919) 787-7246
(919) 787-7247
Mailing address
3801 WAKE FOREST RD STE 210, RALEIGH, NC 27609-6864
(919) 787-7246
(919) 787-7247
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1493M
BCBS
NC
01
—
2022628A
MEDICARE PTAN
NC
05
—
5910579
—
NC
01
—
DP4614
RAILROAD MEDICARE GROUP PTAN
NC
01
—
P00759335
RAILROAD MEDICARE GROUP MEMBER PTAN
NC
Enumeration date
05/04/2009
Last updated
10/20/2021
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