Provider Demographics
NPI:1265632996
Name:PISHARODY, MURALI DHARA (MD)
Entity Type:Individual
Prefix:
First Name:MURALI
Middle Name:DHARA
Last Name:PISHARODY
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:919-774-6518
Mailing Address - Fax:
Practice Address - Street 1:555 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4104
Practice Address - Country:US
Practice Address - Phone:919-774-6518
Practice Address - Fax:919-774-1831
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC135447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH1100710OtherFIRSTCAROLINACARE
P00829221OtherPALMETTO GBA/RR MEDICARE
NC5914545Medicaid
NC153V7OtherBC/BS NC
2073918AMedicare PIN