Provider Demographics
NPI:1255536165
Name:LANDA, ISRAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:LANDA
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 1:6300 CASS HOLT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9759
Mailing Address - Country:US
Mailing Address - Phone:312-420-4878
Mailing Address - Fax:
Practice Address - Street 1:2700 WAYNE MEMORIAL DRIVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-731-6060
Practice Address - Fax:919-731-6534
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059817207P00000X
PAMD430239207P00000X
IL336.079381207P00000X
WV33170207P00000X
NC201300437207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201300437OtherNC MEDICAL LICENSE
NC201300437OtherNC MEDICAL LICENSE