Provider Demographics
NPI:1700827177
Name:ATIEH, MAHMOUD KHADIR (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:KHADIR
Last Name:ATIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:110 FIELDS DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5072
Practice Address - Country:US
Practice Address - Phone:919-777-9005
Practice Address - Fax:919-708-1550
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600116207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12160OtherBC/BS NC PROVIDER#
NCD6775OtherMEDCOST PROVIDER#
NCFH2030305OtherFIRSTCAROLINACARE PROV#
NC5910424Medicaid
NC7000625OtherAETNA PROVIDER#
NCP00171918OtherPALMETTO GBA PROVIDER#
NC043179OtherUNITED HEALTHCARE
NCP00171918OtherPALMETTO GBA PROVIDER#
NC7000625OtherAETNA PROVIDER#
F96648Medicare UPIN