Provider Demographics
NPI:1992757827
Name:PIEDMONT INTERNAL MEDICINE, PULMONARY AND INFECTIOUS DISEASES, PA
Entity type:Organization
Organization Name:PIEDMONT INTERNAL MEDICINE, PULMONARY AND INFECTIOUS DISEASES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-9993
Mailing Address - Street 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-787-9993
Mailing Address - Fax:919-787-7073
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:SUITE 211
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-787-9993
Practice Address - Fax:919-787-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600123207R00000X
NC9600122207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0270POtherBCBS
NC890270PMedicaid
NC2321505Medicare ID - Type Unspecified