Organization
WAKE SPECIALTY PHYSICIANS
Active
Parent organization
WAKE SPECIALTY PHYSICIANS
Other names
WSP-RALEIGH CARDIOLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKE SPECIALTY PHYSICIANS
Authorized official
DR. SUSAN TUCKER WEAVER MD (EXECUTIVE VICE PRESIDENT)
(919) 350-8228
Entity
Organization
Contact information
Practice address
555 MEDICAL PARK PL, SUITE 110, CLAYTON, NC 27520-2174
(919) 861-8939
Mailing address
3000 NEW BERN AVE, SUITE 1200, RALEIGH, NC 27610-1231
(919) 231-6132
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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