Healthcare Provider Details

I. General information

NPI: 1104500420
Provider Name (Legal Business Name): MASOUD EDALATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE CAMPUS BOX #7525, BRINKHOUS-BULLITT BUILDING
CHAPEL HILL NC
27599-7525
US

IV. Provider business mailing address

1100 W NC HIGHWAY 54 BYP APT 29F
CHAPEL HILL NC
27516-2826
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-2647
  • Fax:
Mailing address:
  • Phone: 310-666-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number2026-02284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: