Provider Demographics
NPI:1962519462
Name:RAVENHILL DERMATOLOGY MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:RAVENHILL DERMATOLOGY MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REINELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-891-5524
Mailing Address - Street 1:110 BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 BARCELONA DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4453
Practice Address - Country:US
Practice Address - Phone:910-485-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
83124OtherBLUE CROSS BLUE SHIELD
NC8983124Medicaid
83124OtherBLUE CROSS BLUE SHIELD
NC8983124Medicaid