Provider Demographics
NPI:1114050291
Name:FALLS MEDICAL CENTER PA
Entity Type:Organization
Organization Name:FALLS MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SADAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-676-0202
Mailing Address - Street 1:10931 RAVEN RIDGE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6499
Mailing Address - Country:US
Mailing Address - Phone:919-676-0202
Mailing Address - Fax:919-676-0224
Practice Address - Street 1:10931 RAVEN RIDGE RD
Practice Address - Street 2:STE 115
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-676-0202
Practice Address - Fax:919-676-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118551261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014WYOtherBCBS
NC8974157Medicaid
NC014WYOtherBCBS