Healthcare Provider Details

I. General information

NPI: 1003878224
Provider Name (Legal Business Name): RALEIGH OB/GYN CENTRE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE 405
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

4414 LAKE BOONE TRL SUITE 405
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-875-8225
  • Fax: 919-876-3371
Mailing address:
  • Phone: 919-875-8225
  • Fax: 919-876-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number108804
License Number StateNC

VIII. Authorized Official

Name: MS. GAIL C UZZELL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-876-8225