MEDICARE: RIYAZ H JINNAH MD

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	207X00000X	Orthopaedic Surgery Physician	2006-01492	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487724142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIYAZ H JINNAH MD

Provider Business Mailing Address
First Line	:	2600 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3011
Country	:	US
Telephone Number	:	910-671-5367
Fax Number	:	910-738-3764

Provider Business Practice Location Address
First Line	:	4901 DAWN DR
Second Line	:	SUITE 2300
City	:	LUMBERTON
State	:	NC
Zip	:	28360-8287
Country	:	US
Telephone Number	:	910-738-1065
Fax Number	:	910-738-5143

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	04/27/2017

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