Provider Demographics
NPI:1306202296
Name:FLEXOGENIX NORTH CAROLINA PC
Entity Type:Organization
Organization Name:FLEXOGENIX NORTH CAROLINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NABEEL
Authorized Official - Last Name:MOGANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-455-7803
Mailing Address - Street 1:1000 S HOPE ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1491
Mailing Address - Country:US
Mailing Address - Phone:213-455-7803
Mailing Address - Fax:213-622-6011
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-371-2371
Practice Address - Fax:919-851-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE921Medicare PIN
NC7483130002Medicare NSC