Provider Demographics
NPI:1477378669
Name:NORTH WAKE PEDIATRICS
Entity type:Organization
Organization Name:NORTH WAKE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-932-3506
Mailing Address - Street 1:PO BOX 12160
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4012
Mailing Address - Country:US
Mailing Address - Phone:919-848-2167
Mailing Address - Fax:919-848-2168
Practice Address - Street 1:701 EXPOSITION PL STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3359
Practice Address - Country:US
Practice Address - Phone:919-848-2167
Practice Address - Fax:919-848-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty