Healthcare Provider Details

I. General information

NPI: 1073956637
Provider Name (Legal Business Name): BRYCE ALAN HARBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-3624
  • Fax:
Mailing address:
  • Phone: 919-954-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2019-00111
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101264507
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: