Provider Demographics
NPI:1518922905
Name:WAHBA, WASSEEM JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WASSEEM
Middle Name:JOHN
Last Name:WAHBA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:W JOHN
Other - Middle Name:
Other - Last Name:WAHBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:127 E LAURENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6844
Mailing Address - Country:US
Mailing Address - Phone:919-457-6960
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:WAKE EMERGENCY PHYSICIANS
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW1936OtherHEALTHNET GRP #
AZ453051001OtherGROUP HEALTH GRP #
AZ794744Medicaid
AZ860373636OtherHUMANA GROUP #
AZ3981220OtherEVERCARE GROUP #
AZ860373636OtherHUMANA GROUP #
AZ3981220OtherEVERCARE GROUP #