Healthcare Provider Details

I. General information

NPI: 1851822423
Provider Name (Legal Business Name): KYLE EDWIN ZOLL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

IV. Provider business mailing address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-3966
  • Fax: 919-231-3912
Mailing address:
  • Phone: 919-231-3966
  • Fax: 919-231-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2022-01176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: