Provider Demographics
NPI:1730114026
Name:QURESHI, AYYAZ MAHMOOD (MD)
Entity Type:Individual
Prefix:MR
First Name:AYYAZ
Middle Name:MAHMOOD
Last Name:QURESHI
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 1:505 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027
Mailing Address - Country:US
Mailing Address - Phone:336-548-2456
Mailing Address - Fax:336-548-2917
Practice Address - Street 1:505 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027
Practice Address - Country:US
Practice Address - Phone:336-548-2456
Practice Address - Fax:336-548-2917
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11626OtherPARTNERS
VA6075282Medicaid
NC8969745Medicaid
433041OtherATHEM
NC69745OtherBLUE CROSS SHIELD
NC203097Medicare ID - Type Unspecified
NC69745OtherBLUE CROSS SHIELD