Healthcare Provider Details

I. General information

NPI: 1992757827
Provider Name (Legal Business Name): PIEDMONT INTERNAL MEDICINE, PULMONARY AND INFECTIOUS DISEASES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 CHARLES B ROOT WYND SUITE 211
RALEIGH NC
27612-5440
US

IV. Provider business mailing address

3214 CHARLES B ROOT WYND SUITE 211
RALEIGH NC
27612-5440
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-9993
  • Fax: 919-787-7073
Mailing address:
  • Phone: 919-787-9993
  • Fax: 919-787-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9600123
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9600122
License Number StateNC

VIII. Authorized Official

Name: SYED A MASOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 919-787-9993