MEDICARE: RALEIGH CHILDREN & ADOLESCENTS MEDICINE, PC

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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7901542	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437187010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH CHILDREN & ADOLESCENTS MEDICINE, PC

Provider Business Mailing Address
First Line	:	3100 DURALEIGH RD
Second Line	:	SUITE 300
City	:	RALEIGH
State	:	NC
Zip	:	27612-8106
Country	:	US
Telephone Number	:	919-781-7490
Fax Number	:	919-783-0903

Provider Business Practice Location Address
First Line	:	3100 DURALEIGH RD
Second Line	:	SUITE 300
City	:	RALEIGH
State	:	NC
Zip	:	27612-8106
Country	:	US
Telephone Number	:	919-781-7490
Fax Number	:	919-783-0903

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. THOMAS JOHN SENA
Credential	:	MD
Telephone Number	:	919-781-7490

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/11/2015

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