Individual
DR. SIRAJUDDIN ISMAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
309 PINEYWOOD RD, THOMASVILLE, NC 27360-3438
(336) 474-8921
(336) 474-8923
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 474-8921
(336) 474-8923
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
25MA07585600
NJ
2084P0800X
Psychiatry Physician
Primary
2007-01248
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005266
—
NJ
Enumeration date
07/14/2006
Last updated
10/26/2020
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