Provider Demographics
NPI:1043226574
Name:IQBAL, MOHAMMAD OMER (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:OMER
Last Name:IQBAL
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 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:252-559-2200
Mailing Address - Fax:252-522-9778
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE N
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:252-559-2200
Practice Address - Fax:252-522-9778
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2071127OtherMEDICARE
NC5907451Medicaid