Provider Demographics
NPI:1457542094
Name:RALEIGH, MARY S (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:RALEIGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18818 TELLER AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1678
Mailing Address - Country:US
Mailing Address - Phone:949-535-2322
Mailing Address - Fax:949-535-2330
Practice Address - Street 1:18818 TELLER AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1678
Practice Address - Country:US
Practice Address - Phone:949-535-2322
Practice Address - Fax:949-535-2330
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1968204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1457542094OtherANTHEM
ME433005099Medicaid
ME9807251OtherAETNA
ME1457542094OtherMEDICAL NETWORK
MEAA164093OtherHARVARD PILGRIM
ME000673702Medicare PIN