Provider Demographics
NPI:1003839937
Name:RALEIGH GYNECOLOGY & WELLNESS PA
Entity Type:Organization
Organization Name:RALEIGH GYNECOLOGY & WELLNESS PA
Other - Org Name:WILLIAMS, BENAVIDES & KAMINSKI MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-6700
Mailing Address - Street 1:2304 WESVILL CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2973
Mailing Address - Country:US
Mailing Address - Phone:919-782-6700
Mailing Address - Fax:919-782-2218
Practice Address - Street 1:2304 WESVILL CT
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2973
Practice Address - Country:US
Practice Address - Phone:919-782-6700
Practice Address - Fax:919-782-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32213207V00000X
NC2006-00441207V00000X
NC36223207V00000X
NC2008-01471207V00000X
NCCNM044 ACNM4360367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
012CTOtherBCBS