Organization
LANCET RHEUMATOLOGY AND SARA LUPUS CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NILAMADHAB MISHRA MD (ORGANIZER AND MEMBER)
(336) 918-3421
Entity
Organization
Contact information
Practice address
275 EXECUTIVE PARK BLVD STE 601, WINSTON SALEM, NC 27103
(336) 955-1838
(336) 955-1842
Mailing address
275 EXECUTIVE PARK BLVD STE 601, WINSTON SALEM, NC 27103-1548
(336) 955-1838
(336) 955-1842
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
200000903
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129CV
BCBS
NC
05
—
89129CV
—
NC
01
—
A9429
MEDCOST
NC
Enumeration date
05/25/2016
Last updated
07/23/2018
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