MEDICARE: SHAHLA NAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2014-01425	NC

General Provider Information

NPI Number	:	1073801817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHLA NAZ M.D.

Provider Business Mailing Address
First Line	:	2600 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3011
Country	:	US
Telephone Number	:	910-272-3051
Fax Number	:	910-738-3764

Provider Business Practice Location Address
First Line	:	1249 CHICKEN FOOT RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-7525
Country	:	US
Telephone Number	:	910-423-1278
Fax Number	:	910-423-2547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	11/24/2014

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