Provider Demographics
NPI:1568696748
Name:WAKE SPINE & PAIN SPECIALISTS PC
Entity Type:Organization
Organization Name:WAKE SPINE & PAIN SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUCERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-787-7246
Mailing Address - Street 1:3801 WAKE FOREST RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-787-7246
Mailing Address - Fax:919-787-7247
Practice Address - Street 1:115 KILDAIRE PARK DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-787-7246
Practice Address - Fax:919-787-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1493MOtherBCBS
NCDP4614OtherRAILROAD MEDICARE GROUP PTAN
NC5910579Medicaid
NC2022628AOtherMEDICARE PTAN
NCP00759335OtherRAILROAD MEDICARE GROUP MEMBER PTAN
NCI02147Medicare UPIN
NC5910579Medicaid
NC6541080001Medicare NSC