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General NPI Number Information
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NPI Number | 1497975411
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Entity Type | Organization
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Legal Business Name | MAURICE K. KPEGLO
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 2025 MARTIN L. KING JR DR. SUITE-E
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City | GREENSBORO
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State | NC
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Zip | 27406-3334
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Country | US
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Telephone | 336-378-0760
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Fax | 336-378-0970
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Provider Business Mailing Address
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Address Line | PO BOX 14914
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City | GREENSBORO
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State | NC
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Zip | 27415-4914
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Country | US
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Telephone | 336-378-0760
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Fax | 336-378-0970
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MAURICE KOBLA KPEGLO
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Credential | M.D.
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Telephone | 336-378-0760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 200001360016
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 29314
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License Number State | NC
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