Healthcare Provider Details

I. General information

NPI: 1770671190
Provider Name (Legal Business Name): TEREZA POGHOSYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 VILLAGE DR 201
FAYETTEVILLE NC
28304-3979
US

IV. Provider business mailing address

3186 VILLAGE DR 201
FAYETTEVILLE NC
28304-3979
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5700
  • Fax:
Mailing address:
  • Phone: 910-486-5700
  • Fax: 910-486-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberLL26024
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2009-01117
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: