MEDICARE: OAK ISLAND PEDIATRICS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4773	NC
2	103T00000X	Psychologist	3068	NC
3	208000000X	Pediatrics Physician	9900076	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017HM	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205815685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK ISLAND PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	4734 LONG BEACH RD SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8721
Country	:	US
Telephone Number	:	910-457-0070
Fax Number	:	910-457-0062

Provider Business Practice Location Address
First Line	:	4734 LONG BEACH RD SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8721
Country	:	US
Telephone Number	:	910-457-0070
Fax Number	:	910-457-0062

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUGTA KAHAI
Credential	:	M.D., F.A.A.P.
Telephone Number	:	910-457-0070

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	11/20/2012

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Directions to “OAK ISLAND PEDIATRICS, P.A. ” Practice Location

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