Provider Demographics
NPI:1700104775
Name:BURGAW MEDICAL CENTER, P.C.
Entity type:Organization
Organization Name:BURGAW MEDICAL CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-803-0340
Mailing Address - Street 1:25 N HAMPSTEAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3932
Mailing Address - Country:US
Mailing Address - Phone:910-803-0340
Mailing Address - Fax:910-803-0342
Practice Address - Street 1:25 N HAMPSTEAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3932
Practice Address - Country:US
Practice Address - Phone:910-803-0340
Practice Address - Fax:910-803-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913552Medicaid
NC5917334Medicaid
NC5917334Medicaid
NC2075674BMedicare PIN
NC5913552Medicaid
NC203728AMedicare PIN