Healthcare Provider Details

I. General information

NPI: 1811341027
Provider Name (Legal Business Name): TRIANGLE PHYSICAL MEDICINE OF NORTH HILLS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BARRETT DR STE # 101
RALEIGH NC
27609-6641
US

IV. Provider business mailing address

3900 BARRETT DR STE # 101
RALEIGH NC
27609-6641
US

V. Phone/Fax

Practice location:
  • Phone: 919-809-8860
  • Fax: 919-809-8861
Mailing address:
  • Phone: 919-809-8860
  • Fax: 919-809-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2014-01078
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102815
License Number StateNC

VIII. Authorized Official

Name: JONATHAN ORTON
Title or Position: OWNER
Credential: M.D.
Phone: 919-809-8860