Healthcare Provider Details

I. General information

NPI: 1366298432
Provider Name (Legal Business Name): ABDELRAHMAN FARAG MOHAMED ABDELWAHED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 08/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG ROAD
GREENVILLE NC
27834
US

IV. Provider business mailing address

2100 STANTONSBURG ROAD
GREENVILLE NC
27834
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberABDE-A9EXPP
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL24-0124
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: