Healthcare Provider Details

I. General information

NPI: 1700104775
Provider Name (Legal Business Name): BURGAW MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
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: 910-803-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOSTAFA MOHAMED REZK
Title or Position: OWNER
Credential: DO
Phone: 910-803-0340