Provider Demographics
NPI:1659368108
Name:ACHREJA, MANJEET KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJEET
Middle Name:KAUR
Last Name:ACHREJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANJEET
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:614 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27341-8613
Mailing Address - Country:US
Mailing Address - Phone:336-873-7248
Mailing Address - Fax:336-873-7238
Practice Address - Street 1:614 N BROAD ST
Practice Address - Street 2:
Practice Address - City:SEAGROVE
Practice Address - State:NC
Practice Address - Zip Code:27341-8613
Practice Address - Country:US
Practice Address - Phone:336-873-7248
Practice Address - Fax:336-873-7238
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29458208D00000X, 207Q00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343962AMedicaid
NC343962Medicare PIN
E13840Medicare UPIN