Provider Demographics
NPI:1902899198
Name:ATHAR, MOHAMMED AZHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:AZHAR
Last Name:ATHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:MT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4460
Mailing Address - Country:US
Mailing Address - Phone:336-789-7555
Mailing Address - Fax:336-789-8270
Practice Address - Street 1:826 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4460
Practice Address - Country:US
Practice Address - Phone:336-789-7555
Practice Address - Fax:336-789-8270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912157Medicaid
NCC80960Medicare UPIN
NC8912157Medicaid