Healthcare Provider Details

I. General information

NPI: 1902248073
Provider Name (Legal Business Name): TANVIR IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 DOLLEY MADISON RD STE 100
GREENSBORO NC
27410-4282
US

IV. Provider business mailing address

603 DOLLEY MADISON RD STE 100
GREENSBORO NC
27410-4282
US

V. Phone/Fax

Practice location:
  • Phone: 302-255-2707
  • Fax:
Mailing address:
  • Phone: 302-255-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018-00225
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101265979
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2018-00225
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: