Basic Information
| Provider Information | |||||||||
| NPI: | 1477658250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEHSIN | ||||||||
| FirstName: | ATHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 40908 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106156448 | ||||||||
| FaxNumber: | 9106155070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1638 OWEN DRIVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106156030 | ||||||||
| FaxNumber: | 9106155080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0090-00904 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 2006-01505 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 5905319 | 05 | NC | MEDICAID |