Healthcare Provider Details

I. General information

NPI: 1891150793
Provider Name (Legal Business Name): PRIME MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 OBERLIN RD STE 100
RALEIGH NC
27605-1357
US

IV. Provider business mailing address

702 OBERLIN RD STE 100
RALEIGH NC
27605-1357
US

V. Phone/Fax

Practice location:
  • Phone: 919-948-6355
  • Fax:
Mailing address:
  • Phone: 919-948-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HUMMEL
Title or Position: OWNER
Credential: MD
Phone: 919-880-6649