Provider Demographics
NPI:1437338779
Name:SHAIKH, AZRA PERVEEN (MD)
Entity Type:Individual
Prefix:
First Name:AZRA
Middle Name:PERVEEN
Last Name:SHAIKH
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 1:101 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1935
Mailing Address - Country:US
Mailing Address - Phone:252-823-2105
Mailing Address - Fax:252-824-0389
Practice Address - Street 1:101 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1935
Practice Address - Country:US
Practice Address - Phone:252-823-2105
Practice Address - Fax:252-824-0389
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477POtherBC/BS OF NC
NC5908279Medicaid