Provider Demographics
NPI:1265433684
Name:SPECTRUM INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:SPECTRUM INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIPA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-1800
Mailing Address - Street 1:PO BOX 87022
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7022
Mailing Address - Country:US
Mailing Address - Phone:910-323-1800
Mailing Address - Fax:910-323-4030
Practice Address - Street 1:2944 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5415
Practice Address - Country:US
Practice Address - Phone:910-323-1800
Practice Address - Fax:910-323-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016AUOtherBCBS
NC89016AUMedicaid
NC89016AUMedicaid