Vistar Medical Clinic PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

94-00118 Issued in NC

Legal business name

VISTAR MEDICAL CLINIC PA

Practice address

1004 Bullard CT
Suite 101
Raleigh, NC 27615-6853

Phone

(919) 255-3511

Fax

(888) 249-0062

NPI assigned

Oct 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maximus Eziudo Onuoha, M.D.

Title

Chairman & Ceo

Phone

(919) 255-3511

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1730260134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40028",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276290028",
            "telephone_number": "919-255-3511",
            "fax_number": "888-249-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 BULLARD CT",
            "address_2": "SUITE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276156853",
            "telephone_number": "919-255-3511",
            "fax_number": "888-249-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTAR MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "ONUOHA",
        "authorized_official_first_name": "MAXIMUS",
        "authorized_official_middle_name": "EZIUDO",
        "authorized_official_title_or_position": "CHAIRMAN & CEO",
        "authorized_official_telephone_number": "919-255-3511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "94-00118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950436",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.