1417907544 NPI number — RALEIGH DURHAM MEDICAL GROUP PA

Table of content: DR. MARTIN LEONARD MELNICK M.D. (NPI 1497813661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417907544 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:
ALLIANCE FAMILY PRACTICE
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:
1417907544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 WADE PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-4188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-233-5952
Provider Business Mailing Address Fax Number:
919-854-7774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 FAIR MEADOWS LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-783-9600
Provider Business Practice Location Address Fax Number:
919-783-9675
Provider Enumeration Date:
05/11/2006

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:
919-851-2174

Provider Taxonomy Codes

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

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

  • Identifier: 5900354 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0234V . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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