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General NPI Number Information
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NPI Number | 1083673404
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Entity Type | Organization
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Legal Business Name | SHAMIL J. MORAYATI, MD
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 2921 CROUSE LN
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-585-1212
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Fax | 336-585-1112
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Provider Business Mailing Address
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Address Line | 2921 CROUSE LN
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-585-1212
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Fax | 336-585-1112
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAM J MORAYATI
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Credential | MD
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Telephone | 336-585-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 33871
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License Number State | NC
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