Healthcare Provider Details

I. General information

NPI: 1932661741
Provider Name (Legal Business Name): ABHINAV RAGHAVENDRA KATTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MEDICAL PARK DR STE 202
CONCORD NC
28025-2973
US

IV. Provider business mailing address

315 MEDICAL PARK DR STE 202
CONCORD NC
28025-2973
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS22887
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19786
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036177533
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: