Healthcare Provider Details

I. General information

NPI: 1316238173
Provider Name (Legal Business Name): MOSTAFA MOHAMED REZK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N HAMPSTEAD VILLAGE DR
HAMPSTEAD NC
28443-3932
US

IV. Provider business mailing address

25 N HAMPSTEAD VILLAGE DR
HAMPSTEAD NC
28443-3932
US

V. Phone/Fax

Practice location:
  • Phone: 910-803-0340
  • Fax: 910-803-0342
Mailing address:
  • Phone: 910-803-0340
  • Fax: 910-259-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013-01240
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: