Healthcare Provider Details

I. General information

NPI: 1699945162
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PROFESSIONAL DR
ROXBORO NC
27573-4543
US

IV. Provider business mailing address

5420 WADE PARK BLVD STE. 106
RALEIGH NC
27607-4188
US

V. Phone/Fax

Practice location:
  • Phone: 336-599-9257
  • Fax: 336-599-1593
Mailing address:
  • Phone: 919-851-2174
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOYE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 919-851-2174