Healthcare Provider Details

I. General information

NPI: 1609238708
Provider Name (Legal Business Name): SHIVESH KUMAR VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CRESTHILL DR STE 100
MINT HILL NC
28227-7992
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 980-302-3550
  • Fax: 980-302-3551
Mailing address:
  • Phone: 980-302-3550
  • Fax: 980-302-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60984958
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-01772
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: