Provider Demographics
NPI:1932679446
Name:WAKE MED CHILDREN'S PM PEDIATRIC URGENT CARE
Entity Type:Organization
Organization Name:WAKE MED CHILDREN'S PM PEDIATRIC URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED DIR
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-467-7425
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-869-0650
Mailing Address - Fax:
Practice Address - Street 1:1125 HATCHES POND LN STE 101
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6294
Practice Address - Country:US
Practice Address - Phone:919-467-7425
Practice Address - Fax:909-467-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty