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NPI Code Detail

MEDICARE: DR. SIRAJUDDIN ISMAIL MD

MEDICARE:  DR. SIRAJUDDIN  ISMAIL  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
12084N0402XNeurology with Special Qualifications in Child Neurology Physician25MA07585600NJ
22084P0800XPsychiatry Physician2007-01248NC

Other Identifiers

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

General Provider Information

NPI Number : 1902822901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SIRAJUDDIN ISMAIL MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 336-474-8921
Fax Number : 336-474-8923
Provider Business Practice Location Address
First Line : 309 PINEYWOOD RD
Second Line :
City : THOMASVILLE
State : NC
Zip : 27360-3438
Country : US
Telephone Number : 336-474-8921
Fax Number : 336-474-8923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 10/26/2020

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Directions to “ DR. SIRAJUDDIN ISMAIL MD” Practice Location

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