Provider Demographics
NPI:1548483993
Name:HALIFAX ORTHOPAEDIC & HAND SURGERY CLINIC PA
Entity type:Organization
Organization Name:HALIFAX ORTHOPAEDIC & HAND SURGERY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-535-3091
Mailing Address - Street 1:130 CARDINAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-535-3091
Mailing Address - Fax:252-535-3092
Practice Address - Street 1:130 CARDINAL DRIVE
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-535-3091
Practice Address - Fax:252-535-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24890207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901714Medicaid
C82826Medicare UPIN
NC0694Medicare ID - Type Unspecified