MEDICARE: RALEIGH ORTHOPAEDIC CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1972610756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH ORTHOPAEDIC CLINIC PA

Provider Business Mailing Address
First Line	:	3515 GLENWOOD AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4934
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:	919-782-6578

Provider Business Practice Location Address
First Line	:	11200 GALLERIA AVE STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8137
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:	919-863-6842

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN SCOTT BIZUB
Credential	:
Telephone Number	:	919-863-6801

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/20/2023

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11200 GALLERIA AVE
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1164720496 — MS. JENNIFER OPPENHEIM PASCHALOUDIS MS, RD, LDN
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1336793330 — ANSLEY SWANN PA-C, ATC
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27614-8137

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1699784009 — STEVEN ZAWISTOWSKI O.T.
Practice Location Address:

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1720161466 — MA FARIDA G. ADORO DPT
Practice Location Address:

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1649327750 — ORTHOPAEDIC SPECIALISTS OF NORTH CAROLINA, P.A.
Practice Location Address:

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