Healthcare Provider Details

I. General information

NPI: 1659368108
Provider Name (Legal Business Name): MANJEET KAUR ACHREJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANJEET KAUR MD

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N BROAD ST
SEAGROVE NC
27341-8613
US

IV. Provider business mailing address

614 N BROAD ST
SEAGROVE NC
27341-8613
US

V. Phone/Fax

Practice location:
  • Phone: 336-873-7248
  • Fax: 336-873-7238
Mailing address:
  • Phone: 336-873-7248
  • Fax: 336-873-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29458
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29458
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number29458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: