Healthcare Provider Details

I. General information

NPI: 1033160643
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 NW CARY PKWY
CARY NC
27513-8422
US

IV. Provider business mailing address

5400 TRINITY RD STE 105
RALEIGH NC
27607-6001
US

V. Phone/Fax

Practice location:
  • Phone: 919-238-2000
  • Fax: 919-238-5010
Mailing address:
  • Phone: 919-851-2174
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID K MOYE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 919-851-2174