Organization
BLUE RIDGE MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M.HISHAM ABDEL-AZIZ MOHAMED (PRESIDENT)
(919) 789-0909
Entity
Organization
Contact information
Practice address
3214 CHARLES B ROOT WYND, SUITE 217, RALEIGH, NC 27612-5440
(919) 789-0909
(919) 789-9168
Mailing address
3214 CHARLES B ROOT WYND, SUITE 217, RALEIGH, NC 27612-5440
(919) 789-0909
(919) 789-9168
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
9501610
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891116A
—
NC
Enumeration date
01/09/2007
Last updated
08/22/2020
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