Provider Demographics
NPI:1619099256
Name:FAMILY MEDICAL ASSOCIATES OF RALEIGH, PA
Entity Type:Organization
Organization Name:FAMILY MEDICAL ASSOCIATES OF RALEIGH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, FNP-BC
Authorized Official - Phone:919-875-8150
Mailing Address - Street 1:3500 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7509
Mailing Address - Country:US
Mailing Address - Phone:919-875-8150
Mailing Address - Fax:919-875-9577
Practice Address - Street 1:3500 BUSH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7509
Practice Address - Country:US
Practice Address - Phone:919-875-8150
Practice Address - Fax:919-875-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCH5421OtherRAILROAD MEDICARE
NC8901393Medicaid
NC8901393Medicaid