Provider Demographics
NPI:1558709535
Name:MEDLINK MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:MEDLINK MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:ABDUS
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-641-2100
Mailing Address - Street 1:8518 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-8712
Mailing Address - Country:US
Mailing Address - Phone:336-641-2100
Mailing Address - Fax:336-641-2110
Practice Address - Street 1:2031 MARTIN LUTHER KING JR DR STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3300
Practice Address - Country:US
Practice Address - Phone:336-641-2100
Practice Address - Fax:336-641-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890278LMedicaid
NC2324025Medicare PIN
NCG26366Medicare UPIN