Provider Demographics
NPI:1750340865
Name:RALEIGH EAR, NOSE, & THROAT ASSOC INC
Entity type:Organization
Organization Name:RALEIGH EAR, NOSE, & THROAT ASSOC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-420-2027
Mailing Address - Street 1:PO BOX 18946
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8946
Mailing Address - Country:US
Mailing Address - Phone:919-787-7171
Mailing Address - Fax:919-420-2028
Practice Address - Street 1:3010 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7796
Practice Address - Country:US
Practice Address - Phone:919-787-7171
Practice Address - Fax:919-420-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02498OtherBCBS
230173OtherMEDICARE
NC8902498Medicaid