Healthcare Provider Details

I. General information

NPI: 1437553302
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 DR CALVIN JONES HIGHWAY STE 212
WAKE FOREST NC
27587
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 919-761-5678
  • Fax: 919-761-5680
Mailing address:
  • Phone: 866-557-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOYE
Title or Position: CEO
Credential:
Phone: 919-614-0301