Provider Demographics
NPI:1700848645
Name:ROCKINGHAM INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:ROCKINGHAM INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XAJE
Authorized Official - Middle Name:ADEM
Authorized Official - Last Name:HASANAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-623-5021
Mailing Address - Street 1:507 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-4936
Mailing Address - Country:US
Mailing Address - Phone:336-623-5021
Mailing Address - Fax:336-623-7902
Practice Address - Street 1:507 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-4936
Practice Address - Country:US
Practice Address - Phone:336-623-5021
Practice Address - Fax:336-623-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939986Medicaid
NC8939986Medicaid
NC2202503AMedicare ID - Type Unspecified
NC202131AMedicare ID - Type Unspecified
NC8911662Medicaid