MEDICARE: DR. MAMUN SHAHRIER MD, PHD

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	207RG0100X	Gastroenterology Physician		NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00055459	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	134JU	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1881685428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAMUN SHAHRIER MD, PHD

Provider Business Mailing Address
First Line	:	626 N BICKETT BLVD
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2314
Country	:	US
Telephone Number	:	919-496-2745
Fax Number	:	919-496-3888

Provider Business Practice Location Address
First Line	:	626 N BICKETT BLVD
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2314
Country	:	US
Telephone Number	:	919-496-2745
Fax Number	:	919-496-3888

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/09/2008

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