Healthcare Provider Details

I. General information

NPI: 1659532992
Provider Name (Legal Business Name): THEJASWINI KEMPANANJAPPA KAGGERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MCLAMB PL
GOLDSBORO NC
27534-1647
US

IV. Provider business mailing address

2809 MCLAMB PL
GOLDSBORO NC
27534-1647
US

V. Phone/Fax

Practice location:
  • Phone: 919-580-9840
  • Fax: 919-580-9838
Mailing address:
  • Phone: 919-580-9840
  • Fax: 919-580-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number201000488
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: