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NPI Code Detail

MEDICARE: RALEIGH DURHAM MEDICAL GROUP PA

MEDICARE: RALEIGH DURHAM MEDICAL GROUP PA
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1025VYOTHERNCBCBS

General Provider Information

NPI Number : 1659322436
Entity Type Code : Organization
Provider Name (Legal Business Name) : RALEIGH DURHAM MEDICAL GROUP PA
Provider Business Mailing Address
First Line : 5420 WADE PARK BLVD
Second Line : STE 106
City : RALEIGH
State : NC
Zip : 27607-4188
Country : US
Telephone Number : 919-233-5952
Fax Number : 919-854-7774
Provider Business Practice Location Address
First Line : 2076 HIGHWAY 42 W
Second Line : SUITE 230
City : CLAYTON
State : NC
Zip : 27520-5303
Country : US
Telephone Number : 919-553-5711
Fax Number : 919-553-5712
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DAVID K MOYE
Credential :
Telephone Number : 919-851-2174
Provider Enumeration Date : 05/15/2006
Last Update Date : 03/31/2014

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Directions to “RALEIGH DURHAM MEDICAL GROUP PA ” Practice Location

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