Provider Demographics
NPI:1518144518
Name:JAVED MASOUD P.A.
Entity Type:Organization
Organization Name:JAVED MASOUD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-585-1813
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0209
Mailing Address - Country:US
Mailing Address - Phone:336-585-1813
Mailing Address - Fax:336-585-1816
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:SUITE #1400
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-585-1813
Practice Address - Fax:336-585-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23608261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954624Medicaid
NC2320937Medicare PIN