Healthcare Provider Details

I. General information

NPI: 1013991488
Provider Name (Legal Business Name): TAPAN KUMAR GAYEN MD, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD PITT COUNTY MEMORIAL HOSPITAL
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

3613 CATTAIL LN
GREENVILLE NC
27858-1032
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-5473
  • Fax: 252-847-6255
Mailing address:
  • Phone: 252-258-3609
  • Fax: 252-258-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number200501109
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200501109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: