Basic Information
| Provider Information | |||||||||
| NPI: | 1508484965 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAKHT | ||||||||
| FirstName: | AZAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2379 FORSYTH CT APT D | ||||||||
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| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369340912 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEDICAL CENTER BOULEVARD DEPARTMENT OF PATHOLOGY | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
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| ProviderEnumerationDate: | 07/10/2020 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 261749 | NC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.