Healthcare Provider Details

I. General information

NPI: 1568694149
Provider Name (Legal Business Name): RANDOLPH PULMONARY AND SLEEP CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TANVIR CHODRI
Title or Position: OWNER
Credential: MD
Phone: 336-633-4020