Healthcare Provider Details

I. General information

NPI: 1194851071
Provider Name (Legal Business Name): TRIANGLE ENDOCRINOLOGY AND DIABETES CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WILLIAMS ST SUITE 102
APEX NC
27502-3978
US

IV. Provider business mailing address

PO BOX 1414
APEX NC
27502-3414
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-7576
  • Fax: 919-363-7572
Mailing address:
  • Phone: 919-363-7576
  • Fax: 919-363-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9401482
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SYED ASIF RAZA RIZVI
Title or Position: PRESIDENT
Credential: MD
Phone: 919-363-7576