Healthcare Provider Details

I. General information

NPI: 1932661246
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 213
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 919-896-7066
  • Fax: 919-896-7067
Mailing address:
  • Phone: 919-233-5956
  • Fax: 312-324-7850

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 MOYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-614-0301