Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Other names
WakeMed Childrens Special Infant Care
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN REVICKI PERRY (SLED)
(919) 350-8000
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7846
(919) 350-8147
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790343366
—
NC
Enumeration date
05/30/2019
Last updated
07/23/2025
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