1437463130 NPI number — RALEIGH DURHAM MEDICAL GROUP, PA

Table of content: (NPI 1437463130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437463130 NPI number — RALEIGH DURHAM MEDICAL GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALEIGH DURHAM MEDICAL GROUP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DURHAM FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437463130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28263-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-233-5952
Provider Business Mailing Address Fax Number:
312-324-7850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 BROAD ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-220-9800
Provider Business Practice Location Address Fax Number:
919-220-9500
Provider Enumeration Date:
08/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOYE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
K
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-614-0301

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5915531 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023N5 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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