Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | NC | |
N | 208000000X | Pediatrician | NC |
NPI | 1003894890 |
---|---|
Provider Name | Maqsood Ahmed Valliani |
First Address | Roanoke Rapids, NC 27870-1326 |
Second Address | Roanoke Rapids, NC 27870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2100233 | MAMSI PROVIDER # (01) | NC |
2259181 | UNITED HEALTH CARE # (01) | NC |
89130YP | (05) | NC |
BV7551220 | DEA CERTIFICATE # (01) | NC |
C0598 | MEDCOST LLC PROVIDER # (01) | NC |
H54827 | (02) | NC |