Provider Demographics
NPI:1417845777
Name:REGENESISMD
Entity type:Organization
Organization Name:REGENESISMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-622-4319
Mailing Address - Street 1:8020 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4363
Mailing Address - Country:US
Mailing Address - Phone:919-322-2844
Mailing Address - Fax:919-322-2898
Practice Address - Street 1:8020 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4363
Practice Address - Country:US
Practice Address - Phone:919-322-2844
Practice Address - Fax:919-322-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care