Provider Demographics
NPI:1417166067
Name:MOSALY, NILIMA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:NILIMA
Middle Name:REDDY
Last Name:MOSALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0001
Mailing Address - Country:US
Mailing Address - Phone:984-209-3773
Mailing Address - Fax:
Practice Address - Street 1:2310 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-8710
Practice Address - Country:US
Practice Address - Phone:984-209-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086554207R00000X
NC10-00439208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916517Medicaid
NCFH1101020OtherFIRSTCAROLINA CARE
NC162R1OtherBCBS OF NC
NC8485484OtherCIGNA HEALTH CARE
NCP00906695OtherRR MEDICARE
NC9465225OtherAETNA
NC2077125Medicare Oscar/Certification