Provider Demographics
NPI:1053372961
Name:NORTH RALEIGH CARDIOVASCULAR DISEASES PA
Entity type:Organization
Organization Name:NORTH RALEIGH CARDIOVASCULAR DISEASES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-790-0130
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 409
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-790-0130
Mailing Address - Fax:919-420-7391
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 409
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-790-0130
Practice Address - Fax:919-420-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930667Medicaid
NC206148NMedicare PIN
NCC83663Medicare UPIN