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General NPI Number Information
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NPI Number | 1023504743
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Entity Type | Individual
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Provider Name | MADELEINE REBECCA DINGLASAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY STE 309
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City | RALEIGH
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State | NC
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Zip | 27614
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Country | US
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Telephone | 919-562-9410
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Fax |
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Provider Business Mailing Address
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Address Line | 20 DUKE MEDICINE CIR # 1B1C
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City | DURHAM
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State | NC
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Zip | 27710-2000
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Country | US
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Telephone | 919-681-8746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1152316
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License Number State | NC
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