Provider Demographics
NPI:1336110196
Name:CHAZLI, FIRAS (MD)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:
Last Name:CHAZLI
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:PO BOX 10707
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27532-0707
Mailing Address - Country:US
Mailing Address - Phone:919-736-0400
Mailing Address - Fax:919-736-0426
Practice Address - Street 1:2501 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9436
Practice Address - Country:US
Practice Address - Phone:919-736-0400
Practice Address - Fax:919-736-0426
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01199207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC187926OtherMEDCOST
NC7685274OtherAETNA
NC1044XOtherBCBS
NCP00246446OtherRAILROAD MEDICARE
NC6728576OtherCIGNA
NC8922102Medicaid
NCP00246446OtherRAILROAD MEDICARE
NC2222312GMedicare ID - Type Unspecified