Healthcare Provider Details

I. General information

NPI: 1669883435
Provider Name (Legal Business Name): NORTH HILLS INTERNAL & INTEGRATIVE MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 SIX FORKS RD
RALEIGH NC
27609-5269
US

IV. Provider business mailing address

4822 SIX FORKS RD
RALEIGH NC
27609-5269
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-1675
  • Fax: 919-977-3398
Mailing address:
  • Phone: 919-977-1675
  • Fax: 919-977-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number28586
License Number StateNC

VIII. Authorized Official

Name: HENRY JOSEPH VAN PALA
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 919-662-8633