Provider Demographics
NPI:1497211189
Name:WAKE SKIN CANCER CENTER, PA
Entity type:Organization
Organization Name:WAKE SKIN CANCER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:EMILE
Authorized Official - Last Name:AYLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-436-4124
Mailing Address - Street 1:11640 NORTHPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5741
Mailing Address - Country:US
Mailing Address - Phone:919-436-4124
Mailing Address - Fax:
Practice Address - Street 1:11640 NORTHPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5741
Practice Address - Country:US
Practice Address - Phone:919-436-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty