Provider Demographics
NPI:1710512314
Name:MIDTOWN RALEIGH ANESTHESIA
Entity Type:Organization
Organization Name:MIDTOWN RALEIGH ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGRECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-881-9999
Mailing Address - Street 1:2600 ATLANTIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1502
Mailing Address - Country:US
Mailing Address - Phone:919-881-9999
Mailing Address - Fax:919-881-9998
Practice Address - Street 1:2600 ATLANTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1502
Practice Address - Country:US
Practice Address - Phone:919-881-9999
Practice Address - Fax:919-881-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty