Healthcare Provider Details

I. General information

NPI: 1679788962
Provider Name (Legal Business Name): GOVINDA BRAHMANDAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-7725
  • Fax:
Mailing address:
  • Phone: 417-347-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2015-00922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: