Healthcare Provider Details

I. General information

NPI: 1376463984
Provider Name (Legal Business Name): RALEIGH DURHAM MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 CAROLINA BEACH RD STE A
WILMINGTON NC
28412-3672
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 910-790-3660
  • Fax: 910-790-9499
Mailing address:
  • Phone: 866-557-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JING ZHANG
Title or Position: MD
Credential:
Phone: 919-859-5650