Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 2017-00687 | NC |
NPI | 1013262419 |
---|---|
Provider Name | Mr. Marat Fudim |
First Address | Morganton, NC 28655-4093 |
Second Address | Durham, NC 27710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 04/06/2018 |