MEDICARE: TRIANGLE FAMILY MEDICINE, PA

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	2006-01349	NC

General Provider Information

NPI Number	:	1184926024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIANGLE FAMILY MEDICINE, PA

Provider Business Mailing Address
First Line	:	5233 SUNSET LAKE RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-3793
Country	:	US
Telephone Number	:	919-387-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	5233 SUNSET LAKE RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-3793
Country	:	US
Telephone Number	:	919-387-8885
Fax Number	:

Authorized Official
Title or Position	:	INCORPORATOR
Name	:	DR. SAMREEN AZEEM
Credential	:	M D
Telephone Number	:	919-387-8885

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	01/14/2011

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