Provider Demographics
NPI:1215931894
Name:SANGMUAH, ELIZA N (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:N
Last Name:SANGMUAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MATTHEWS STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5373
Mailing Address - Country:US
Mailing Address - Phone:704-246-3936
Mailing Address - Fax:704-771-1931
Practice Address - Street 1:101 E MATTHEWS STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5373
Practice Address - Country:US
Practice Address - Phone:704-246-3936
Practice Address - Fax:704-771-1931
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902523Medicaid
NC5902523Medicaid
2049034Medicare ID - Type Unspecified
H79203Medicare UPIN