Provider Demographics
NPI:1073610119
Name:NORTH RALEIGH PSYCHIATRY, PA
Entity Type:Organization
Organization Name:NORTH RALEIGH PSYCHIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-9554
Mailing Address - Street 1:5530 MUNFORD RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2638
Mailing Address - Country:US
Mailing Address - Phone:919-782-9554
Mailing Address - Fax:919-782-9130
Practice Address - Street 1:5530 MUNFORD RD
Practice Address - Street 2:SUITE 119
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2638
Practice Address - Country:US
Practice Address - Phone:919-782-9554
Practice Address - Fax:919-782-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0144FOtherNC BLUE CROSSBLUE SHIELD
NC890144FMedicaid
NC0144FOtherNC BLUE CROSSBLUE SHIELD