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Organization
VISTAR MEDICAL CLINIC PA
Active
Organization
VISTAR MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAXIMUS EZIUDO ONUOHA M.D. (CHAIRMAN & CEO)
(919) 255-3511
Entity
Organization
Contact information
Practice address
1004 BULLARD CT, SUITE 101, RALEIGH, NC 27615-6853
(919) 255-3511
(888) 249-0062
Mailing address
PO BOX 40028, RALEIGH, NC 27629-0028
(919) 255-3511
(888) 249-0062
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
94-00118
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950436
—
NC
Enumeration date
10/18/2006
Last updated
02/13/2020
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