Healthcare Provider Details

I. General information

NPI: 1043357791
Provider Name (Legal Business Name): RANDOLPH PULMONARY & SLEEP CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FAYETTEVILLE ST SUITE 300
ASHEBORO NC
27203-4670
US

IV. Provider business mailing address

610 N FAYETTEVILLE ST SUITE 300
ASHEBORO NC
27203-4670
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-4020
  • Fax: 336-633-4069
Mailing address:
  • Phone: 336-633-4020
  • Fax: 336-633-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. TANVIR CHODRI
Title or Position: PARTNER
Credential: MD
Phone: 336-633-4020