Provider Demographics
NPI:1437109139
Name:RALEIGH INFECTIOUS DISEASES ASSOCIATES PA
Entity Type:Organization
Organization Name:RALEIGH INFECTIOUS DISEASES ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-571-1567
Mailing Address - Street 1:2304 WESVILL CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2973
Mailing Address - Country:US
Mailing Address - Phone:919-571-1567
Mailing Address - Fax:919-782-1472
Practice Address - Street 1:2304 WESVILL COURT
Practice Address - Street 2:SUITE 240
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-571-1567
Practice Address - Fax:919-782-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39179207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0239EOtherBCBS
NC5922139Medicaid
NC0239EOtherBCBS