Provider Demographics
NPI:1134226301
Name:CAPE FEAR PHYSICAL MEDICINE AND
Entity type:Organization
Organization Name:CAPE FEAR PHYSICAL MEDICINE AND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MEISHA
Authorized Official - Middle Name:KAMA
Authorized Official - Last Name:ABBASINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-630-1112
Mailing Address - Street 1:PO BOX 64575
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-630-1112
Mailing Address - Fax:910-425-1110
Practice Address - Street 1:1540 PURDUE DRIVE
Practice Address - Street 2:STE. 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-630-1112
Practice Address - Fax:910-425-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDD3414OtherMEDICARE RAIL ROAD
NC5900744Medicaid
NC2346520Medicare PIN