Healthcare Provider Details

I. General information

NPI: 1982691663
Provider Name (Legal Business Name): ANOOP KUMAR KALIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 X RAY DR
GASTONIA NC
28054-7488
US

IV. Provider business mailing address

1054 X RAY DRIVE
GASTONIA NC
28054-4725
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-0054
  • Fax: 704-853-0075
Mailing address:
  • Phone: 704-853-0054
  • Fax: 704-853-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200200711
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: