Provider Demographics
NPI:1003894890
Name:VALLIANI, MAQSOOD AHMED (MD)
Entity Type:Individual
Prefix:
First Name:MAQSOOD
Middle Name:AHMED
Last Name:VALLIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-1326
Mailing Address - Country:US
Mailing Address - Phone:252-536-5000
Mailing Address - Fax:252-536-2258
Practice Address - Street 1:2066 NC 125 HWY
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:252-536-5000
Practice Address - Fax:252-536-2258
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-01403207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130YPMedicaid
NCC0598OtherMEDCOST LLC PROVIDER #
NC2001-01403OtherNC MEDICAL LICENSE #
NC2100233OtherMAMSI PROVIDER #
NC2259181OtherUNITED HEALTH CARE #
NCC0598OtherMEDCOST LLC PROVIDER #
NC2299239AMedicare ID - Type UnspecifiedCIGNA MEDICARE #