Healthcare Provider Details

I. General information

NPI: 1508941535
Provider Name (Legal Business Name): RALEIGH PEDIATRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 FALLS VALLEY DR
RALEIGH NC
27615-3446
US

IV. Provider business mailing address

1921 FALLS VALLEY DR
RALEIGH NC
27615-3446
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-0250
  • Fax:
Mailing address:
  • Phone: 919-872-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JERRY C. BERNSTEIN
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 919-872-0250