Healthcare Provider Details

I. General information

NPI: 1306898531
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 RAVEN RIDGE RD STE 105
RALEIGH NC
27614-6487
US

IV. Provider business mailing address

5400 TRINITY RD STE 105
RALEIGH NC
27607-6001
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-0543
  • Fax: 919-235-0542
Mailing address:
  • Phone: 919-851-2174
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID K MOYE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 919-851-2174