Provider Demographics
NPI:1326065301
Name:NORTH WAKE INTERNAL MEDICINE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NORTH WAKE INTERNAL MEDICINE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-848-6388
Mailing Address - Street 1:10000 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7838
Mailing Address - Country:US
Mailing Address - Phone:919-848-6946
Mailing Address - Fax:919-848-4899
Practice Address - Street 1:10000 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7838
Practice Address - Country:US
Practice Address - Phone:919-848-6946
Practice Address - Fax:919-848-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339508Medicare ID - Type Unspecified