Provider Demographics
NPI:1932661246
Name:RALEIGH DURHAM MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:RALEIGH DURHAM MEDICAL GROUP, PA
Other - Org Name:HEALTHPARK PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-614-0301
Mailing Address - Street 1:PO BOX 63103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3103
Mailing Address - Country:US
Mailing Address - Phone:919-233-5956
Mailing Address - Fax:312-324-7850
Practice Address - Street 1:8300 HEALTH PARK STE 213
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-896-7066
Practice Address - Fax:919-896-7067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALEIGH DURHAM MEDICAL GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty