Provider Demographics
NPI:1063636298
Name:CAPE CENTER OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:CAPE CENTER OBSTETRICS & GYNECOLOGY
Other - Org Name:CAPE CENTER OBSTETRICS AND GYNECOLOGY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAHBEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-5322
Mailing Address - Street 1:3609 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-323-5322
Mailing Address - Fax:910-323-2389
Practice Address - Street 1:3609 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-323-5322
Practice Address - Fax:910-323-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27098207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985230Medicaid
NC89012H3Medicaid
NC89012H3Medicaid
NC211223CMedicare ID - Type Unspecified
NC8985230Medicaid