Provider Demographics
NPI:1093058307
Name:BABA, TILAK RAJ
Entity type:Individual
Prefix:
First Name:TILAK
Middle Name:RAJ
Last Name:BABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 KIMEL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6967
Mailing Address - Country:US
Mailing Address - Phone:336-768-6211
Mailing Address - Fax:336-768-6869
Practice Address - Street 1:195 KIMEL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6967
Practice Address - Country:US
Practice Address - Phone:336-768-6211
Practice Address - Fax:336-768-6869
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD044449208M00000X
MDD0081092208M00000X
NC202203303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist