Provider Demographics
NPI:1538401161
Name:ALAMANCE INTERNAL AND NUCLEAR MEDICINE
Entity type:Organization
Organization Name:ALAMANCE INTERNAL AND NUCLEAR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYEGH
Authorized Official - Middle Name:
Authorized Official - Last Name:JADALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-586-9799
Mailing Address - Street 1:2961 CROUSE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8833
Mailing Address - Country:US
Mailing Address - Phone:336-586-9799
Mailing Address - Fax:336-586-9760
Practice Address - Street 1:2961 CROUSE LN
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-586-9799
Practice Address - Fax:336-586-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAMANCE INTERNAL AND NUCLEAR MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700604207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891042XMedicaid
NC2238803AMedicare PIN
NC891042XMedicaid