Healthcare Provider Details

I. General information

NPI: 1588891022
Provider Name (Legal Business Name): KAVITTA BAMAN ALLEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 FALLS OF NEUSE RD STE 106
RALEIGH NC
27614-8495
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-6450
  • Fax: 919-350-7204
Mailing address:
  • Phone: 760-704-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA125319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2012-00472
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: