Provider Demographics
NPI:1255204368
Name:LANCET RHEUMATOLOGY AND SARA LUPUS CLINIC
Entity type:Organization
Organization Name:LANCET RHEUMATOLOGY AND SARA LUPUS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NILAMADHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-955-1838
Mailing Address - Street 1:275 EXECUTIVE PARK BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1548
Mailing Address - Country:US
Mailing Address - Phone:336-955-1838
Mailing Address - Fax:336-955-1842
Practice Address - Street 1:275 EXECUTIVE PARK BLVD STE 601
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1548
Practice Address - Country:US
Practice Address - Phone:336-955-1838
Practice Address - Fax:336-955-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty