Healthcare Provider Details

I. General information

NPI: 1659323319
Provider Name (Legal Business Name): KAMLESH V ATHAVALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27705-3941
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax: 919-620-4921
Mailing address:
  • Phone: 919-684-8111
  • Fax: 919-620-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2006-01493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: