Provider Demographics
NPI:1184926024
Name:TRIANGLE FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:TRIANGLE FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:919-387-8885
Mailing Address - Street 1:5233 SUNSET LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-3793
Mailing Address - Country:US
Mailing Address - Phone:919-387-8885
Mailing Address - Fax:
Practice Address - Street 1:5233 SUNSET LAKE RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-3793
Practice Address - Country:US
Practice Address - Phone:919-387-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIANGLE FAMILY MEDICINE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty