Basic Information
| Provider Information | |||||||||
| NPI: | 1174561815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT ENDOCRINOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16414 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275166414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664978332 | ||||||||
| FaxNumber: | 9199676647 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 S MAIN ST | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245412927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347914070 | ||||||||
| FaxNumber: | 4347914072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | MAHMOUD | ||||||||
| AuthorizedOfficialFirstName: | HATIM | ||||||||
| AuthorizedOfficialMiddleName: | AHMED | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4347914070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 0101234987 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 289591 | 01 | VA | BC/BS - MAHMOUD | OTHER | 890668G | 05 | NC | MEDICAID |