Provider Demographics
NPI:1255449112
Name:YACOUB, SHERIF ZAGHLOUL (MD)
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:ZAGHLOUL
Last Name:YACOUB
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:
Practice Address - Street 1:3510 N HIGHWAY 17 STE 220
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8245
Practice Address - Country:US
Practice Address - Phone:843-724-2011
Practice Address - Fax:843-606-7991
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24928207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC249289Medicaid
TN1506326Medicaid
SC249289Medicaid
SCAA80699223Medicare PIN
VA1255449112Medicaid
TN3700592Medicare UPIN
TN1506326Medicaid
TN3001898Medicare UPIN
SCAA0899Medicare ID - Type Unspecified