Provider Demographics
NPI:1205835832
Name:FAKHRI, MOUHAMED IYAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUHAMED
Middle Name:IYAD
Last Name:FAKHRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-7628
Mailing Address - Country:US
Mailing Address - Phone:252-258-3475
Mailing Address - Fax:
Practice Address - Street 1:741B TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5507
Practice Address - Country:US
Practice Address - Phone:252-258-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891350KMedicaid
NC1350KOtherBLUE CROSS BLUE SHIELD
I01668Medicare UPIN
NC2021691BMedicare ID - Type Unspecified