Provider Demographics
NPI:1669444022
Name:RALEIGH PRIMARY CARE MEDICINE, PA
Entity Type:Organization
Organization Name:RALEIGH PRIMARY CARE MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALWINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-6655
Mailing Address - Street 1:3200 FAIRHILL DR
Mailing Address - Street 2:STE. 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3218
Mailing Address - Country:US
Mailing Address - Phone:919-781-6655
Mailing Address - Fax:919-781-0306
Practice Address - Street 1:3200 FAIRHILL DR
Practice Address - Street 2:STE. 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3218
Practice Address - Country:US
Practice Address - Phone:919-781-6655
Practice Address - Fax:919-781-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2205481FOtherMEDICARE
NC8976117Medicaid