Healthcare Provider Details

I. General information

NPI: 1134010143
Provider Name (Legal Business Name): VITAL HUB MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 HOLLY SPRINGS RD STE 108
HOLLY SPRINGS NC
27540-9634
US

IV. Provider business mailing address

401 IVY ARBOR WAY
HOLLY SPRINGS NC
27540-4812
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-9865
  • Fax: 919-322-9865
Mailing address:
  • Phone: 919-322-9865
  • Fax: 919-322-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAGHAVENDER GOTUR
Title or Position: OWNER / MANAGER
Credential: MD
Phone: 919-322-9865