Provider Demographics
NPI:1780698753
Name:BIZUNEH, AMSALU MOGES (MD)
Entity type:Individual
Prefix:DR
First Name:AMSALU
Middle Name:MOGES
Last Name:BIZUNEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2240 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4725
Mailing Address - Country:US
Mailing Address - Phone:704-671-5311
Mailing Address - Fax:704-671-5308
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-5416
Practice Address - Fax:704-384-5992
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-01183207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905497Medicaid
SCN01183Medicaid
NCP00375657OtherRAILROAD MEDICARE
NCI62057Medicare UPIN
NC5905497Medicaid