Provider Demographics
NPI:1134343452
Name:FREIJI, RULA MUSA (MD)
Entity type:Individual
Prefix:
First Name:RULA
Middle Name:MUSA
Last Name:FREIJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RULA
Other - Middle Name:M
Other - Last Name:FREIJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PARK DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2948
Practice Address - Country:US
Practice Address - Phone:704-403-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40981208000000X
NC2010-01895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1683485Medicaid
LAG95319Medicare UPIN
LA1683485Medicaid