Provider Demographics
NPI:1750688438
Name:LS OF RALEIGH
Entity type:Organization
Organization Name:LS OF RALEIGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CENTER OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-457-0340
Mailing Address - Street 1:10208 CERNY ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10208 CERNY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7884
Practice Address - Country:US
Practice Address - Phone:919-457-0340
Practice Address - Fax:919-806-2123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PREVENTION GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty