Healthcare Provider Details

I. General information

NPI: 1114478385
Provider Name (Legal Business Name): RDMG ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CANTERBURY RD
SMITHFIELD NC
27577-4861
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 919-934-5149
  • Fax: 919-934-5632
Mailing address:
  • Phone: 919-233-5952
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOYE
Title or Position: DIRECTOR
Credential:
Phone: 919-233-5956