MEDICARE: BARTLETT- RALEIGH INTERNAL MEDICINE GROUP, P. C.

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	207R00000X	Internal Medicine Physician	N/A	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	123821	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386685246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTLETT- RALEIGH INTERNAL MEDICINE GROUP, P. C.

Provider Business Mailing Address
First Line	:	8357 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38133-2138
Country	:	US
Telephone Number	:	901-371-0200
Fax Number	:	901-383-1178

Provider Business Practice Location Address
First Line	:	8357 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38133-2138
Country	:	US
Telephone Number	:	901-210-6197
Fax Number	:	901-383-1178

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HERMINIO B BALDERAMA
Credential	:	M.D.
Telephone Number	:	901-210-6197

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/23/2021

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