Provider Demographics
NPI:1013371061
Name:RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:RALEIGH DURHAM MEDICAL GROUP, PA
Other - Org Name:HORIZON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-614-0301
Mailing Address - Street 1:PO BOX 63103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3103
Mailing Address - Country:US
Mailing Address - Phone:919-233-5952
Mailing Address - Fax:312-324-7850
Practice Address - Street 1:236 BUTTERNUT LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5857
Practice Address - Country:US
Practice Address - Phone:919-359-1011
Practice Address - Fax:919-359-9122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALEIGH DURHAM MEDICAL GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty