Provider Demographics
NPI:1144229519
Name:FARIAS, SHOBHA M (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:M
Last Name:FARIAS
Suffix:
Gender:F
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:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1354
Mailing Address - Country:US
Mailing Address - Phone:910-642-4711
Mailing Address - Fax:910-642-3232
Practice Address - Street 1:329 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3601
Practice Address - Country:US
Practice Address - Phone:910-642-4711
Practice Address - Fax:910-642-3232
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC31148OtherBCBS OF NC
NC8931148Medicaid
C81611Medicare UPIN
NC203016Medicare ID - Type Unspecified