Provider Demographics
NPI:1417313602
Name:NEUSE VALLEY INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:NEUSE VALLEY INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-791-2900
Mailing Address - Street 1:701 EXPOSITION PL
Mailing Address - Street 2:SUITE 218
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3300
Mailing Address - Country:US
Mailing Address - Phone:919-791-2900
Mailing Address - Fax:919-845-2568
Practice Address - Street 1:701 EXPOSITION PL
Practice Address - Street 2:SUITE 218
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3300
Practice Address - Country:US
Practice Address - Phone:919-791-2900
Practice Address - Fax:919-845-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty