Provider Demographics
NPI:1205829066
Name:AL-HAIDARY, ANWAR DARWISH
Entity type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:DARWISH
Last Name:AL-HAIDARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BARRETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7213
Mailing Address - Country:US
Mailing Address - Phone:919-231-3966
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:2503 WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4426
Practice Address - Country:US
Practice Address - Phone:252-243-2268
Practice Address - Fax:252-243-2917
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300006207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910489Medicaid
NCF58472Medicare UPIN
NC8910489Medicaid