Healthcare Provider Details

I. General information

NPI: 1164626941
Provider Name (Legal Business Name): DR. GENTIANA BAKAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MOYE BLVD FL 2 ECU PHYSICIANS INTERNAL MEDICINE
GREENVILLE NC
27834-2849
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3229
  • Fax: 252-744-3924
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201001450
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: