Healthcare Provider Details

I. General information

NPI: 1801870795
Provider Name (Legal Business Name): NEETA KUKREJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 PARK RD
CHARLOTTE NC
28210-6568
US

IV. Provider business mailing address

1636 LOOKOUT CIR
WAXHAW NC
28173-8085
US

V. Phone/Fax

Practice location:
  • Phone: 704-540-6860
  • Fax:
Mailing address:
  • Phone: 704-540-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9701800
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: