Provider Demographics
NPI:1871545319
Name:WESTERN WAKE MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:WESTERN WAKE MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-233-3959
Mailing Address - Street 1:530 NEW WAVERLY PL
Mailing Address - Street 2:STE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7414
Mailing Address - Country:US
Mailing Address - Phone:919-233-3959
Mailing Address - Fax:919-233-1003
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:STE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-233-3959
Practice Address - Fax:919-233-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902167Medicaid
NC2329415Medicare PIN