Provider Demographics
NPI:1124077664
Name:ABO-KAMIL, TARIQ (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:ABO-KAMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-1080
Mailing Address - Fax:252-436-1082
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 006
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-436-1080
Practice Address - Fax:252-436-1082
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501451207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902536Medicaid
NC5902536Medicaid
NCPTAN 4767A576Medicare PIN
NCI43525Medicare UPIN