Provider Demographics
NPI:1154327021
Name:RALEIGH SURGICAL GROUP, INC.
Entity Type:Organization
Organization Name:RALEIGH SURGICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-8210
Mailing Address - Street 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:STE 503
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-782-8210
Mailing Address - Fax:919-781-4650
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:STE 503
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-782-8210
Practice Address - Fax:919-781-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89023SQMedicaid
NC0235QOtherBCBS
2322559Medicare ID - Type Unspecified