Provider Demographics
NPI:1194047340
Name:WAKE EAR NOSE AND THROAT SPECIALISTS PLLC
Entity type:Organization
Organization Name:WAKE EAR NOSE AND THROAT SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-943-9287
Mailing Address - Street 1:115 PARKWAY OFFICE CT STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7431
Mailing Address - Country:US
Mailing Address - Phone:919-851-5636
Mailing Address - Fax:919-851-7247
Practice Address - Street 1:115 PARKWAY OFFICE CT STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7431
Practice Address - Country:US
Practice Address - Phone:919-851-5636
Practice Address - Fax:919-851-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023442BOtherMEDICARE GROUP PTAN
G59382Medicare UPIN