1013928449 NPI number — DENIS P RALEIGH MD PLLC

Table of content: (NPI 1013928449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013928449 NPI number — DENIS P RALEIGH MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENIS P RALEIGH MD PLLC
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:
Provider Other Organization Name Type Code:
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:
1013928449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40257-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-614-6376
Provider Business Mailing Address Fax Number:
502-614-7817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-4689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-614-6376
Provider Business Practice Location Address Fax Number:
502-614-7817
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RALEIGH
Authorized Official First Name:
DENIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MD OWNER
Authorized Official Telephone Number:
502-614-6376

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65945107 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE8228 . This is a "RAILROAD MCARE KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200081150 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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