Healthcare Provider Details

I. General information

NPI: 1528115961
Provider Name (Legal Business Name): RAGINI T MADAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTHPLEX WAY SUITE 220
APEX NC
27502
US

IV. Provider business mailing address

120 HEALTHPLEX WAY 220
APEX NC
27502-8403
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-0550
  • Fax: 919-350-9822
Mailing address:
  • Phone: 919-350-0550
  • Fax: 919-350-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9800950
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8911660
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: