Provider Demographics
NPI:1093783474
Name:AGHA, MAHER SALAH (MD)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:SALAH
Last Name:AGHA
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 1:7108 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8371
Mailing Address - Country:US
Mailing Address - Phone:704-542-2191
Mailing Address - Fax:704-542-4243
Practice Address - Street 1:7108 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8371
Practice Address - Country:US
Practice Address - Phone:704-542-2191
Practice Address - Fax:704-542-4243
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001175762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891009HMedicaid
2231671BMedicare ID - Type Unspecified
NCG36685Medicare UPIN