Provider Demographics
NPI:1427144104
Name:JADALI, FAYEGH (MD PHD)
Entity type:Individual
Prefix:DR
First Name:FAYEGH
Middle Name:
Last Name:JADALI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 CROUSE LANE STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:336-586-9799
Mailing Address - Fax:336-589-9760
Practice Address - Street 1:2961 CROUSE LANE STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-586-9799
Practice Address - Fax:336-589-9760
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700604207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891042XMedicaid
NC1042XOtherBCBS
NC0403383OtherUHC
G53762Medicare UPIN
NC891042XMedicaid