Basic Information
| Provider Information | |||||||||
| NPI: | 1003894890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALLIANI | ||||||||
| FirstName: | MAQSOOD | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1326 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278701326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365000 | ||||||||
| FaxNumber: | 2525362258 | ||||||||
| Practice Location | |||||||||
| Address1: | 2066 NC 125 HWY | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365000 | ||||||||
| FaxNumber: | 2525362258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | NC | X | Allopathic & Osteopathic Physicians | Allergy & Immunology | 208000000X | NC | X | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | C0598 | 01 | NC | MEDCOST LLC PROVIDER # | OTHER | BV7551220 | 01 | NC | DEA CERTIFICATE # | OTHER | 89130YP | 05 | NC | MEDICAID | 2259181 | 01 | NC | UNITED HEALTH CARE # | OTHER | 2100233 | 01 | NC | MAMSI PROVIDER # | OTHER |