WAKEMED SPECIALISTS GROUP LLC NPI 1063076453

NPI Information

  • NPI: 1063076453
  • Provider Name: WAKEMED SPECIALISTS GROUP LLC
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • :
  • CLIA Number: 34D1096201
  • Address: 3024 NEW BERN AVE
    RALEIGH, NC
    ZIP 27610
  • Phone: (919) 350-1380

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NPI Details

WAKEMED SPECIALISTS GROUP LLC is an obstetrics gynecology in Raleigh, NC. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. WAKEMED SPECIALISTS GROUP LLC NPI is 1063076453. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

3024 NEW BERN AVE
RALEIGH, NC
ZIP 27610-247
Phone: (919) 350-1380
Fax: (919) 556-0124

The provider's authorized official is Karen Revicki Perry .
The authorized official title is Sled and has the following contact phone number (919) 350-8000.

The CLIA number assigned to this NPI record is 34D1096201 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/1/2019 and was last updated on 7/23/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207VG0400XObstetrics & GynecologyGynecologyNo
2207VX0000XObstetrics & GynecologyObstetricsNo
3207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11063076453MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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