Basic Information
Provider Information
NPI: 1730565490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALESKEROV
FirstName: FUAD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1234 HUFFMAN MILL ROAD
Address2:  
City: BURLINGTON
State: NC
PostalCode: 272158700
CountryCode: US
TelephoneNumber: 3365381234
FaxNumber: 3365846811
Practice Location
Address1: 1234 HUFFMAN MILL ROAD
Address2:  
City: BURLINGTON
State: NC
PostalCode: 272158700
CountryCode: US
TelephoneNumber: 3365381234
FaxNumber: 3365846811
Other Information
ProviderEnumerationDate: 08/05/2015
LastUpdateDate: 03/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD34583ALN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X2019-01416NCY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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