Healthcare Provider Details

I. General information

NPI: 1477215358
Provider Name (Legal Business Name): HEALTHCARE DIRECT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CREEDMOOR RD STE 102
RALEIGH NC
27613-1711
US

IV. Provider business mailing address

7200 CREEDMOOR RD STE 102
RALEIGH NC
27613-1711
US

V. Phone/Fax

Practice location:
  • Phone: 919-719-2270
  • Fax: 919-488-5152
Mailing address:
  • Phone: 919-719-2270
  • Fax: 919-488-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW KANAAN
Title or Position: MANAGER
Credential: DO
Phone: 919-791-5583