Healthcare Provider Details

I. General information

NPI: 1396788188
Provider Name (Legal Business Name): MUKESH NAUTAM KAMDAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL SUITE 201
RALEIGH NC
27607-7512
US

IV. Provider business mailing address

4201 LAKE BOONE TRL SUITE 201
RALEIGH NC
27607-7512
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-0384
  • Fax: 919-785-0038
Mailing address:
  • Phone: 919-785-0384
  • Fax: 919-785-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38105
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number38105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: