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Individual

MADIHA EMRAN SOOFI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
600 MOYE BLVD, GREENVILLE, NC 27834-4300
(252) 744-2803
(252) 744-3616
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069

Taxonomy

Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
2019-00909
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2019-00909
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1275096497
NC
01
2019-00909
NORTH CAROLINA MEDICAL BOARD LICENSE
NC
01
201W9
BCBS OF NC
NC
01
NN6849A
MEDICARE
NC
Enumeration date
04/14/2019
Last updated
08/21/2019
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