Healthcare Provider Details

I. General information

NPI: 1669719209
Provider Name (Legal Business Name): RHEUMATOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SIX FORKS RD SUITE 207
RALEIGH NC
27609-3890
US

IV. Provider business mailing address

5711 SIX FORKS RD SUITE 207
RALEIGH NC
27609-3890
US

V. Phone/Fax

Practice location:
  • Phone: 919-841-9002
  • Fax: 919-841-9954
Mailing address:
  • Phone: 919-841-9002
  • Fax: 919-841-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK WIENER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-841-9002