1669444022 NPI number — RALEIGH PRIMARY CARE MEDICINE, PA

Table of content: (NPI 1669444022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669444022 NPI number — RALEIGH PRIMARY CARE MEDICINE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALEIGH PRIMARY CARE MEDICINE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669444022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 FAIRHILL DR
Provider Second Line Business Mailing Address:
STE. 106
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-6655
Provider Business Mailing Address Fax Number:
919-781-0306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 FAIRHILL DR
Provider Second Line Business Practice Location Address:
STE. 106
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-6655
Provider Business Practice Location Address Fax Number:
919-781-0306
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIDHU
Authorized Official First Name:
BALWINDER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-781-6655

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2205481F . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8976117 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com