Healthcare Provider Details

I. General information

NPI: 1124374939
Provider Name (Legal Business Name): MUHAMMAD UMER TARIQ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WH SMITH BLVD
GREENVILLE NC
27834-3763
US

IV. Provider business mailing address

850 WH SMITH BLVD
GREENVILLE NC
27834-3763
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-5521
  • Fax:
Mailing address:
  • Phone: 252-816-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2022-00964
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number57.021896
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: