# BLUE RIDGE MEDICAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770632077
- **Authorized official:** M.HISHAM ABDEL-AZIZ MOHAMED (PRESIDENT)
- **Authorized official phone:** (919) 789-0909

## Contact information

- **Practice address:** 3214 CHARLES B ROOT WYND, SUITE 217, RALEIGH, NC 27612-5440
- **Practice address phone:** (919) 789-0909
- **Practice address fax:** (919) 789-9168
- **Mailing address:** 3214 CHARLES B ROOT WYND, SUITE 217, RALEIGH, NC 27612-5440
- **Mailing address phone:** (919) 789-0909
- **Mailing address fax:** (919) 789-9168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 9501610 | NC | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 08/22/2020