Healthcare Provider Details

I. General information

NPI: 1487604971
Provider Name (Legal Business Name): MOHAMMAD MAROOF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 ED DR SUITE 104 & 108
RALEIGH NC
27612-8004
US

IV. Provider business mailing address

3917 CITY OF OAKS WYND
RALEIGH NC
27612-5308
US

V. Phone/Fax

Practice location:
  • Phone: 919-783-8377
  • Fax: 866-347-8377
Mailing address:
  • Phone: 919-788-8827
  • Fax: 866-347-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22655
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number22655
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number22655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: