Healthcare Provider Details

I. General information

NPI: 1013067784
Provider Name (Legal Business Name): ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 HARDEN RD SUITE 102
RALEIGH NC
27607-3369
US

IV. Provider business mailing address

3633 HARDEN RD SUITE 102
RALEIGH NC
27607-3369
US

V. Phone/Fax

Practice location:
  • Phone: 919-788-8797
  • Fax: 919-788-8797
Mailing address:
  • Phone: 919-788-8797
  • Fax: 919-788-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBYN A HERNDON
Title or Position: FRONT OFFICE MANAGER
Credential:
Phone: 919-788-8797