Healthcare Provider Details

I. General information

NPI: 1790913861
Provider Name (Legal Business Name): RALEIGH EAR, NOSE, AND THROAT HEAD AND NECK SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 ANDERSON DR
RALEIGH NC
27609-7796
US

IV. Provider business mailing address

PO BOX 18946
RALEIGH NC
27619-8946
US

V. Phone/Fax

Practice location:
  • Phone: 919-420-2029
  • Fax: 919-420-2028
Mailing address:
  • Phone: 919-787-7171
  • Fax: 919-420-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE P DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-420-2027