Provider Demographics
NPI:1285674952
Name:RALEIGH DERMATOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:RALEIGH DERMATOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-876-3656
Mailing Address - Street 1:800 SPRINGFIELD COMMONS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8533
Mailing Address - Country:US
Mailing Address - Phone:919-876-3656
Mailing Address - Fax:919-876-2351
Practice Address - Street 1:800 SPRINGFIELD COMMONS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8533
Practice Address - Country:US
Practice Address - Phone:919-876-3656
Practice Address - Fax:919-876-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty