1114125895 NPI number — DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.

Table of content: MOHAMMAD TABRAIZE SIDDIQUE M. D. (NPI 1144439456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114125895 NPI number — DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DUKE URGENT CARE - SOUTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114125895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27709-5566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-620-4855
Provider Business Mailing Address Fax Number:
919-620-4921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5716 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-9089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-572-1868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DIVISIONAL COO
Authorized Official Telephone Number:
919-668-6008

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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