Healthcare Provider Details

I. General information

NPI: 1396139028
Provider Name (Legal Business Name): LINA QAZI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WEST 27TH STREET SOUTHEASTERN HEALTH
LUMBERTON NC
28359
US

IV. Provider business mailing address

300 WEST 27TH STREET SOUTHEASTERN HEALTH
LUMBERTON NC
28359
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-2662
  • Fax: 910-272-7153
Mailing address:
  • Phone: 910-738-2662
  • Fax: 910-272-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number208302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: