Provider Demographics
NPI:1730579848
Name:REJUVENATION MD, P.A.
Entity type:Organization
Organization Name:REJUVENATION MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMBREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-633-4034
Mailing Address - Street 1:610 N FAYETTEVILLE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4670
Mailing Address - Country:US
Mailing Address - Phone:336-633-4034
Mailing Address - Fax:336-633-4069
Practice Address - Street 1:610 N FAYETTEVILLE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4670
Practice Address - Country:US
Practice Address - Phone:336-633-4034
Practice Address - Fax:336-633-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501252208600000X
NC200400470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty