Healthcare Provider Details

I. General information

NPI: 1609296185
Provider Name (Legal Business Name): NITHIN BHAGWANDASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 08/07/2022
Certification Date: 08/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S MAIN ST
HOLLY SPRINGS NC
27540-8906
US

IV. Provider business mailing address

593 PAT CRUZ
EL PASO TX
79932-4107
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7093
  • Fax:
Mailing address:
  • Phone: 409-392-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2022-00041
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3637
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022-00041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: