Provider Demographics
NPI:1790973469
Name:WAKE FOREST PEDIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WAKE FOREST PEDIATRIC ASSOCIATES, PLLC
Other - Org Name:WFPA, PLLC - KNIGHTDALE PEDIATRIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-266-5059
Mailing Address - Street 1:6845 KNIGHTDALE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9651
Mailing Address - Country:US
Mailing Address - Phone:919-266-5059
Mailing Address - Fax:919-266-4309
Practice Address - Street 1:6845 KNIGHTDALE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9651
Practice Address - Country:US
Practice Address - Phone:919-266-5059
Practice Address - Fax:919-266-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty