| Blue Ridge Medical Group Pa | |
|
3214 Charles B Root Wynd Suite 217 Raleigh NC 27612-5440 | |
| (919) 789-0909 | |
| (919) 789-9168 |
| Full Name | Blue Ridge Medical Group Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 3214 Charles B Root Wynd, Raleigh, North Carolina |
| Authorized Official Name and Position | M.hisham Abdel-aziz Mohamed (PRESIDENT) |
| Authorized Official Contact | 9197890909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Medical Group Pa 3214 Charles B Root Wynd Suite 217 Raleigh NC 27612-5440 Ph: (919) 789-0909 | Blue Ridge Medical Group Pa 3214 Charles B Root Wynd Suite 217 Raleigh NC 27612-5440 Ph: (919) 789-0909 |
| NPI Number | 1770632077 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2860306081 |
|---|---|
| Medicare Enrollment ID | O20130719000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770632077 | NPI | - | NPPES |
| 891116A | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 9501610 (North Carolina) | Primary |
| Provider Name | M Hisham A Mohamed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205909496 PECOS PAC ID: 5395659510 Enrollment ID: I20031113000045 |
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