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General NPI Number Information
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NPI Number | 1871327080
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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 | 08/29/2024
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 405 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3411
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Country | US
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Telephone | 910-323-3183
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96860
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City | CHARLOTTE
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State | NC
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Zip | 28296-6860
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Country | US
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Telephone | 866-557-2612
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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