Provider Demographics
NPI:1841263852
Name:MOHAMED, FAZIL A II (MD)
Entity type:Individual
Prefix:
First Name:FAZIL
Middle Name:A
Last Name:MOHAMED
Suffix:II
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 1:1721 ALLENS LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3661
Mailing Address - Country:US
Mailing Address - Phone:910-239-5902
Mailing Address - Fax:910-239-5908
Practice Address - Street 1:1721 ALLENS LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3661
Practice Address - Country:US
Practice Address - Phone:910-239-5902
Practice Address - Fax:910-239-5908
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND201001263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC266429Medicaid
SC266429Medicaid
SCH99955Medicare UPIN