Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1968 | ME |
Y | 207Q00000X | Family Doctor | 1968 | ME |
NPI | 1457542094 |
---|---|
Provider Name | Dr. Mary S Raleigh |
First Address | Irvine, CA 92612-1678 |
Second Address | Irvine, CA 92612-1678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1457542094 | ANTHEM (01) | ME |
1457542094 | MEDICAL NETWORK (01) | ME |
433005099 | (05) | ME |
9807251 | AETNA (01) | ME |
AA164093 | HARVARD PILGRIM (01) | ME |