Healthcare Provider Details

I. General information

NPI: 1225227309
Provider Name (Legal Business Name): PC MEDICAL DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FAYETTEVILLE ST SUITE 104
ASHEBORO NC
27203-4670
US

IV. Provider business mailing address

610 N FAYETTEVILLE ST SUITE 104
ASHEBORO NC
27203-4670
US

V. Phone/Fax

Practice location:
  • Phone: 336-672-6000
  • Fax: 336-672-6001
Mailing address:
  • Phone: 336-672-6000
  • Fax: 336-672-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: IMRAN PASHA HAQUE
Title or Position: OWNER
Credential: MD
Phone: 336-672-6000