Provider Demographics
NPI:1194851071
Name:TRIANGLE ENDOCRINOLOGY AND DIABETES CLINIC PA
Entity Type:Organization
Organization Name:TRIANGLE ENDOCRINOLOGY AND DIABETES CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED ASIF
Authorized Official - Middle Name:RAZA
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-363-7576
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3414
Mailing Address - Country:US
Mailing Address - Phone:919-363-7576
Mailing Address - Fax:919-363-7572
Practice Address - Street 1:1001 W WILLIAMS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3978
Practice Address - Country:US
Practice Address - Phone:919-363-7576
Practice Address - Fax:919-363-7572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401482207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00574Medicare UPIN
NC2209506BMedicare PIN