Individual
MIRA H GHNEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
517 MOYE BLVD, ECU PHYSICIANS TRAUMA SURGERY, GREENVILLE, NC 27834-2849
(252) 847-4299
(252) 847-8208
Mailing address
PO BOX 751069, ECU PHYSICIANS, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2016-00821
NC
208600000X
Surgery Physician
BP1-0037256
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265757942
—
NC
01
—
19KJA
BCBS OF NC
NC
Enumeration date
04/06/2010
Last updated
11/09/2016
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