Healthcare Provider Details

I. General information

NPI: 1104962315
Provider Name (Legal Business Name): RALEIGH MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BARRETT DR STE 300
RALEIGH NC
27609-7213
US

IV. Provider business mailing address

PO BOX 18563
RALEIGH NC
27619-8563
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-1806
  • Fax: 919-782-4756
Mailing address:
  • Phone: 919-782-1806
  • Fax: 919-782-1669

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 Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY R HEWLIN
Title or Position: PRACTICE IMPLEMENTATION MANAGER
Credential:
Phone: 919-341-3623