Provider Demographics
NPI:1912951252
Name:MUNTHER S TABET MD PA
Entity Type:Organization
Organization Name:MUNTHER S TABET MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNTHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:TABET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-436-0092
Mailing Address - Street 1:120 CHARLES ROLLINS RD STE.101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-436-0092
Mailing Address - Fax:
Practice Address - Street 1:120 CHARLES ROLLINS ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-436-0092
Practice Address - Fax:252-436-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98015232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015GWMedicaid
NC2338059Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER