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General NPI Number Information
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NPI Number | 1518918259
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Entity Type | Organization
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Legal Business Name | RALEIGH DURHAM MEDICAL GROUP, PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 7205 STONEHENGE DR
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City | RALEIGH
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State | NC
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Zip | 27613-1649
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Country | US
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Telephone | 919-848-2249
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Fax | 919-848-8238
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Provider Business Mailing Address
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Address Line | PO BOX 63103
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City | CHARLOTTE
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State | NC
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Zip | 28263-3103
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Country | US
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Telephone | 919-233-5952
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Fax | 312-324-7850
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DAVID K MOYE
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Credential |
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Telephone | 919-614-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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