Provider Demographics
NPI:1386685246
Name:BARTLETT- RALEIGH INTERNAL MEDICINE GROUP, P. C.
Entity Type:Organization
Organization Name:BARTLETT- RALEIGH INTERNAL MEDICINE GROUP, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMINIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALDERAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-210-6197
Mailing Address - Street 1:8357 MEMPHIS ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2138
Mailing Address - Country:US
Mailing Address - Phone:901-371-0200
Mailing Address - Fax:901-383-1178
Practice Address - Street 1:8357 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2138
Practice Address - Country:US
Practice Address - Phone:901-210-6197
Practice Address - Fax:901-383-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNN/A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702480Medicaid
TN123821OtherBLUE CROSS BLUE SHIELD
TN123821OtherBLUE CROSS BLUE SHIELD