Provider Demographics
NPI:1083673404
Name:SHAMIL J. MORAYATI, MD
Entity Type:Organization
Organization Name:SHAMIL J. MORAYATI, MD
Other - Org Name:BURLINGTON MEDICAL CTR/CAROLINA NUCLEAR MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-585-1212
Mailing Address - Street 1:2921 CROUSE LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8833
Mailing Address - Country:US
Mailing Address - Phone:336-585-1212
Mailing Address - Fax:336-585-1112
Practice Address - Street 1:2921 CROUSE LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-585-1212
Practice Address - Fax:336-585-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33871305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890114EMedicaid
NC2322081Medicare ID - Type Unspecified
NC890114EMedicaid