Healthcare Provider Details

I. General information

NPI: 1245412758
Provider Name (Legal Business Name): MANPREET SINGH BHUTANI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANPREET SINGH MBBS

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

10217 SWANHAVEN CT
RALEIGH NC
27617-7558
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone: 919-596-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2009-00046
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: