Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Physician Practices Urogynecology
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXEC DIRECTOR, FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
10010 FALLS OF NEUSE RD, RALEIGH, NC 27614-8494
(919) 350-1380
(919) 556-0124
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
—
—
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
05/26/2015
Last updated
03/14/2018
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