Provider Demographics
NPI:1174309553
Name:GLENWOOD DIRECT PRIMARY CARE PLLC
Entity type:Organization
Organization Name:GLENWOOD DIRECT PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABID
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-605-7318
Mailing Address - Street 1:5623 DURALEIGH RD STE 141
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2700
Mailing Address - Country:US
Mailing Address - Phone:919-322-0730
Mailing Address - Fax:919-615-0113
Practice Address - Street 1:5623 DURALEIGH RD STE 141
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2700
Practice Address - Country:US
Practice Address - Phone:919-322-0730
Practice Address - Fax:919-615-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care