Provider Demographics
NPI:1821047648
Name:RALEIGH PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:RALEIGH PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMBETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-872-2616
Mailing Address - Street 1:1112 DRESSER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7303
Mailing Address - Country:US
Mailing Address - Phone:919-872-2616
Mailing Address - Fax:919-872-2771
Practice Address - Street 1:1112 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7303
Practice Address - Country:US
Practice Address - Phone:919-872-2616
Practice Address - Fax:919-872-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902506Medicaid
NC8902506Medicaid