Healthcare Provider Details

I. General information

NPI: 1093129207
Provider Name (Legal Business Name): SAMEER MIRZA BAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MALCOLM BLVD STE 200
CONNELLY SPRINGS NC
28612-7920
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 420
MORRISVILLE NC
27560-5491
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-7654
  • Fax:
Mailing address:
  • Phone: 984-974-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME145429
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2018-01484
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: