Provider Demographics
NPI:1306021407
Name:TIGHE, DEVIN KENDRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:KENDRICK
Last Name:TIGHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 GREENS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4612
Mailing Address - Country:US
Mailing Address - Phone:919-781-1437
Mailing Address - Fax:
Practice Address - Street 1:3704 NORTH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3658
Practice Address - Country:US
Practice Address - Phone:318-442-8399
Practice Address - Fax:318-448-9897
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0265402085R0202X
VA01012730902085R0202X
NC2021-025712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306021407OtherNPI
LA1063282Medicaid
LA4N949Medicare UPIN