Provider Demographics
NPI:1760444921
Name:RALEIGH CENTER FOR NEUROSURGERY & NEUROSCIENCES, PA
Entity Type:Organization
Organization Name:RALEIGH CENTER FOR NEUROSURGERY & NEUROSCIENCES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LACIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-8313
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7514
Mailing Address - Country:US
Mailing Address - Phone:919-781-8313
Mailing Address - Fax:919-781-8330
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-781-8313
Practice Address - Fax:919-781-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347886Medicare ID - Type Unspecified