Wake Skin Cancer Center, PA

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

WAKE SKIN CANCER CENTER, PA

Practice address

11640 Northpark Dr Ste 200
Wake Forest, NC 27587-5741

Phone

(919) 436-4124

NPI assigned

Feb 18, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elias Emile Ayli, DONPI 1376706101

Title

President

Phone

(919) 436-4124

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elias Emile Ayli, D.O.

  • MOHS-Micrographic Surgery Physician
  • Wake Forest, NC
  • NPI 1376706101
  Medicare reassignment Care Compare group NPD Authorized official
• Osward Yadiel Carrasquillo Gonzalez, MD, MPH

  • Dermatology Physician
  • Chapel Hill, NC
  • NPI 1336535855
  Medicare reassignment Care Compare group NPD
• Edward Michael Galiczynski Jr., DO

  • Dermatology Physician
  • Wake Forest, NC
  • NPI 1255517041

  Mohs-Micrographic Surgery

  Medicare reassignment Care Compare group NPD
• Lauren Kramer, NP

  • Dermatology Physician
  • Wake Forest, NC
  • NPI 1295414563
  Medicare reassignment Care Compare group NPD
• Candice Hesse Coble, PA-C

  • Medical Physician Assistant
  • Cary, NC
  • NPI 1407143159
  Medicare reassignment Care Compare group
• Jada Marie Dillner, PA-C

  • Physician Assistant
  • Wake Forest, NC
  • NPI 1225789662
  Medicare reassignment Care Compare group
• Audrey Jean Furnas, PA-C

  • Physician Assistant
  • Wake Forest, NC
  • NPI 1548576309
  Medicare reassignment Care Compare group
• Monica Locke

  • Physician Assistant
  • Pittsburgh, PA
  • NPI 1396131504

  NC

  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1497211189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11640 NORTHPARK DR STE 200",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875741",
            "telephone_number": "919-436-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11640 NORTHPARK DR STE 200",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875741",
            "telephone_number": "919-436-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SKIN CANCER CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-18",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "AYLI",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_middle_name": "EMILE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-436-4124",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wake Forest Performance and Rehab
• Wake Forest Physical Therapy
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• Wake Forest Urgent Care, PLLC
• Wake Heart and Vascular Associates P.a.
• Wake Specialty Physicians
• Wake Specialty Physicians LLC
• Wake Specialty Physicians LLC
• Wake Specialty Physicians LLC
• Wakefield Eye Care, OD PLLC

• MOHS-Micrographic Surgery Physician in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• MOHS-Micrographic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.