Provider Demographics
NPI:1619915501
Name:RALEIGH FOOT CENTER,PA
Entity Type:Organization
Organization Name:RALEIGH FOOT CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-850-9111
Mailing Address - Street 1:PO BOX 98209
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-8209
Mailing Address - Country:US
Mailing Address - Phone:919-850-9111
Mailing Address - Fax:919-850-2499
Practice Address - Street 1:1418 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4812
Practice Address - Country:US
Practice Address - Phone:919-850-9111
Practice Address - Fax:919-850-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89081EMedicaid
NC2431990AOtherMEDICARE ID-PTAN
NC89081EMedicaid