Organization
ACTIVE FOOT AND ANKLE OF CAROLINA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUNJED SALEM DPM (OWNER)
(252) 333-3111
Entity
Organization
Contact information
Practice address
1076 US HIGHWAY 17 S, ELIZABETH CITY, NC 27909-7627
(252) 333-3111
(252) 333-1105
Mailing address
632 CEDAR RD STE B, CHESAPEAKE, VA 23322-8376
(757) 547-0123
(757) 547-2412
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
623
NC
335E00000X
Prosthetic/Orthotic Supplier
623
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558681197
—
NC
Enumeration date
04/22/2016
Last updated
04/18/2019
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