MEDICARE: RALEIGH RADIOLOGY ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1144831611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH RADIOLOGY ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	5220 GREENS DAIRY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-4612
Country	:	US
Telephone Number	:	919-256-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LATTNER CT STE 101
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9584
Country	:	US
Telephone Number	:	919-781-1437
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	SATISH MATHAN
Credential	:	MD
Telephone Number	:	919-781-1437

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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