Provider Demographics
NPI:1467561662
Name:RALEIGH GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:RALEIGH GASTROENTEROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-788-7760
Mailing Address - Street 1:4201 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 005
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7512
Mailing Address - Country:US
Mailing Address - Phone:919-788-7760
Mailing Address - Fax:919-788-7764
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 005
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-788-7760
Practice Address - Fax:919-788-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty