Provider Demographics
NPI:1437187010
Name:RALEIGH CHILDREN & ADOLESCENTS MEDICINE, PC
Entity Type:Organization
Organization Name:RALEIGH CHILDREN & ADOLESCENTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-7490
Mailing Address - Street 1:3100 DURALEIGH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:919-781-7490
Mailing Address - Fax:919-783-0903
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-781-7490
Practice Address - Fax:919-783-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901542OtherBCBS
NC7901542Medicaid