MEDICARE: NORTH RALEIGH INTEGRATED PRIMARY CARE PLLC

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	207QA0505X	Adult Medicine Physician

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

General Provider Information

NPI Number	:	1447844162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH RALEIGH INTEGRATED PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	4040 BARRETT DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6640
Country	:	US
Telephone Number	:	919-689-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 BARRETT DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6640
Country	:	US
Telephone Number	:	919-689-1010
Fax Number	:

Authorized Official
Title or Position	:	PM
Name	:	TRESHELL HERNDON
Credential	:
Telephone Number	:	919-689-1010

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	12/09/2025

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