Provider Demographics
NPI:1114152337
Name:DABIRUDDIN M HUMAYUN MD, PLLC
Entity Type:Organization
Organization Name:DABIRUDDIN M HUMAYUN MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DABIRUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMAYUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-781-4900
Mailing Address - Street 1:PO BOX 15133
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0133
Mailing Address - Country:US
Mailing Address - Phone:919-477-5345
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:3830 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4319
Practice Address - Country:US
Practice Address - Phone:919-781-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02DQUOtherBCBS OF NC
NC89138G3Medicaid