1356699904 NPI number — DR. MOHAMMAD RAIHAN AZAD MD

Table of content: CARMEL L BROOKS MA (NPI 1467718692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356699904 NPI number — DR. MOHAMMAD RAIHAN AZAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZAD
Provider First Name:
MOHAMMAD
Provider Middle Name:
RAIHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356699904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3202 GREY FOX TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-660-9636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 WH SMITH BLVD.
Provider Second Line Business Practice Location Address:
PHYSICIANS EAST - ENDOCRINOLOGY
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-413-6683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2017-01167 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 2017-01167 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03007063/NWK , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01131126/RGH , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".