Provider Demographics
NPI:1073858080
Name:TRIANGLE FORENSIC NEUROPSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:TRIANGLE FORENSIC NEUROPSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:AMRISH
Authorized Official - Last Name:FOZDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-906-0868
Mailing Address - Street 1:4700 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6200
Mailing Address - Country:US
Mailing Address - Phone:919-906-0868
Mailing Address - Fax:
Practice Address - Street 1:4700 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6200
Practice Address - Country:US
Practice Address - Phone:919-906-0868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty