Provider Demographics
NPI:1457398380
Name:TRIANGLE PREMIER WOMEN'S HEALTH, P.A.
Entity Type:Organization
Organization Name:TRIANGLE PREMIER WOMEN'S HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-934-3015
Mailing Address - Street 1:520 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4016
Mailing Address - Country:US
Mailing Address - Phone:919-934-3015
Mailing Address - Fax:919-934-0958
Practice Address - Street 1:520 NORTH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4016
Practice Address - Country:US
Practice Address - Phone:919-934-3015
Practice Address - Fax:919-934-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79017616Medicaid
NCC82241Medicare UPIN
NC2311027Medicare ID - Type Unspecified