Healthcare Provider Details

I. General information

NPI: 1952820128
Provider Name (Legal Business Name): RDMG ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 SOUTHPARK DR STE 110
DURHAM NC
27713-7736
US

IV. Provider business mailing address

PO BOX 63103
CHARLOTTE NC
28263-3103
US

V. Phone/Fax

Practice location:
  • Phone: 984-219-1562
  • Fax: 984-219-2366
Mailing address:
  • Phone: 919-233-5952
  • Fax: 312-324-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-614-0301