Provider Demographics
NPI:1083226906
Name:RELYMD MEDICAL GROUP NC, PLLC
Entity Type:Organization
Organization Name:RELYMD MEDICAL GROUP NC, PLLC
Other - Org Name:RELYMD MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CREATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-932-0928
Mailing Address - Street 1:510 MEADOWMONT VILLAGE CIR STE 323
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7584
Mailing Address - Country:US
Mailing Address - Phone:919-932-0928
Mailing Address - Fax:
Practice Address - Street 1:212 S TRYON ST STE 1000
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28281-0001
Practice Address - Country:US
Practice Address - Phone:919-932-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELYMD MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-21
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty