MEDICARE: SHOBHA M FARIAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	27173	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31148	OTHER	NC	BCBS OF NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144229519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOBHA M FARIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1354
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-1354
Country	:	US
Telephone Number	:	910-642-4711
Fax Number	:	910-642-3232

Provider Business Practice Location Address
First Line	:	329 JEFFERSON ST
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-3601
Country	:	US
Telephone Number	:	910-642-4711
Fax Number	:	910-642-3232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/29/2012

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