Provider Demographics
NPI:1902220254
Name:TOLBA, LAMIAA MOHAMED ABBAS (PA-C, DMSC, MPAS)
Entity Type:Individual
Prefix:DR
First Name:LAMIAA
Middle Name:MOHAMED ABBAS
Last Name:TOLBA
Suffix:
Gender:F
Credentials:PA-C, DMSC, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:125 QUEENS RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3215
Mailing Address - Country:US
Mailing Address - Phone:980-302-6600
Mailing Address - Fax:980-302-6605
Practice Address - Street 1:125 QUEENS RD STE 600
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:980-302-6600
Practice Address - Fax:980-302-6605
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1867PAMedicaid
NC1902220254Medicaid
NCNCH740BMedicare PIN
NC1902220254Medicaid
SC1867PAMedicaid