RALEIGH OB/GYN (NPI# 1154722072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154722072 |
| Entity Type | Organization |
| Organization Name | RALEIGH OB/GYN |
| Practice Address |
4414 Lake Boone Trl Suite 405 Raleigh NC 27607-7513 |
| Mailing Address |
1501 Yamato Rd Suite 200 West Boca Raton FL 33431-4438 |
| Practice Telephone | 9198768225 |
| Practice Fax Number | 9198763371 |
| Mailing Telephone | 5613002410 |
| Mailing Fax Number | 5619534146 |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-09-10 |
| Authorized Official Name | MS. KATHRYN GARRETT (DIRECTOR MANAGED CARE) |
| Authorized Official Telephone | 5613002410 |
| Is Organization Subpart | Y |
| Parent Organization Name | UWH OF NORTH CAROLINA LLP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Street Address |
4414 LAKE BOONE TRL SUITE 405 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27607-7513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194729772 | Hugh Judd Grant Jr. | Obstetrics & Gynecology | 4414 Lake Boone Trl, Ste 210, Raleigh, NC 27607-7505 | 2005-06-10 |
| 1194175505 | Terence Makoid | Nurse Practitioner | 4414 Lake Boone Trl, Raleigh, NC 27607-7513 | 2016-06-16 |
| 1578925152 | Nastaran Gharkholonarehe | Pharmacist | 4414 Lake Boone Trl, Suite # 108, Raleigh, NC 27607-7513 | 2016-03-23 |
| 1689062176 | Kristin Lauer Allison | Nurse Practitioner | 4414 Lake Boone Trl, Suite 405, Raleigh, NC 27607-7513 | 2015-01-06 |
| 1457752305 | Centre Ob/gyn | Obstetrics & Gynecology | 4414 Lake Boone Trl, Suite 205, Raleigh, NC 27607-7513 | 2014-09-10 |
| 1427458629 | Kristie Reynolds Clontz | Nurse Practitioner | 4414 Lake Boone Trl, Suite 108, Raleigh, NC 27607-7513 | 2014-08-26 |
| 1699181917 | Jessica Hope Mullenix | Nurse Practitioner | 4414 Lake Boone Trl, Suite 402, Raleigh, NC 27607-7513 | 2014-07-08 |
| 1851706543 | Wha P.k.a. Wilkerson Obgyn | Medical Genetics, Ph.D. Medical Genetics | 4414 Lake Boone Trl, Suite 210, Raleigh, NC 27607-7513 | 2014-06-22 |
| 1053660530 | Jenifer Rae Briscoe-brimmage | Obstetrics & Gynecology | 4414 Lake Boone Trl, Suite 405, Raleigh, NC 27607-7513 | 2012-08-30 |
| 1861777468 | Rex Hospital Inc | Internal Medicine | 4414 Lake Boone Trl, Suite 402, Raleigh, NC 27607-7513 | 2011-10-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972093144 | Kyndra Lawson | Behavior Technician | 5121 Kingdom Way, Suite 100, Raleigh, NC 27607 | 2018-05-14 |
| 1578082905 | Margaret Roberts Bova | Dietitian, Registered | 4207 Lake Boone Trail, Suite 210, Raleigh, NC 27607 | 2017-09-18 |
| 1184141897 | Chricat Garrard | Nurse Practitioner | 4207 Lake Boone Trl Ste 200, Raleigh, NC 27607 | 2017-08-23 |
| 1487178620 | John Patrick Morton | Pharmacist | 2411 Landmark Dr, Raleigh, NC 27607 | 2017-07-31 |
| 1023538857 | Heather Margaret Mazzola | Audiologist | 7800 Lake Boone Trail, 100, Raleigh, NC 27607 | 2017-06-22 |
| 1790216984 | North Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2411 Landmark Drive, Raleigh, NC 27607 | 2017-03-21 |
| 1558819516 | Corilin Nocito Meggitt | Nurse Practitioner | 4505 Fair Meadows Ln Ste 102, Raleigh, NC 27607 | 2016-09-19 |
| 1942757034 | Stacie Walker | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 311, Raleigh, NC 27607 | 2016-09-06 |
| 1831644533 | Alisa Smajlagic Howe | Nurse Practitioner | 4210 Lake Boone Trail, Rex Rehab & Nursing Center, Raleigh, NC 27607 | 2016-08-23 |
| 1235598632 | Yoseph Saleh | Dentist | 107 Minden Ln, Raleigh, NC 27607 | 2016-02-15 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396212080 | Fatima Sayyeda Ahmed | Obstetrics & Gynecology | 4904 Majestic Prince Ct, Raleigh, NC 27606-4269 | 2018-10-31 |
| 1457752511 | Carolina Gynecology Pa | Obstetrics & Gynecology | 700 Exposition Place, Suite 161, Raleigh, NC 27615-1563 | 2014-09-09 |
| 1134567787 | Brian Conrad Brimmage | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 405, Raleigh, NC 27607 | 2013-06-05 |
| 1629414164 | Aileen Jenna Beckham | Obstetrics & Gynecology | 3024 New Bern Ave Ste 309, Raleigh, NC 27610-1247 | 2013-05-10 |
| 1437436854 | Bassam Husam Rimawi | Obstetrics & Gynecology | 23 Sunnybrook Rd Ste 316, Raleigh, NC 27610-1874 | 2011-11-14 |
| 1891021853 | Private Diagnostic Clinic, Pllc | Obstetrics & Gynecology | 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 | 2009-10-27 |
| 1013159094 | Mary Carolyn Peavey | Obstetrics & Gynecology | 7920 Acc Blvd Ste 300, Raleigh, NC 27617-8744 | 2009-04-06 |
| 1821258518 | Kenneth Joseph Fortier | Obstetrics & Gynecology | 3701 Holly Ln, Unit 203, Raleigh, NC 27612-8051 | 2008-06-16 |
| 1093973075 | Patricia Ann Convery | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 205, Raleigh, NC 27607 | 2008-05-27 |
| 1063603124 | David Masao Kawasaki | Obstetrics & Gynecology | 9124 Palm Bay Cir, Raleigh, NC 27617-7776 | 2007-08-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.