Healthcare Provider Details

I. General information

NPI: 1689636433
Provider Name (Legal Business Name): KIRAN K JAGARLAMUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 BRENNER AVE SUITE 102
SALISBURY NC
28144-2558
US

IV. Provider business mailing address

611 MOCKSVILLE AVE
SALISBURY NC
28144-2705
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-7220
  • Fax: 704-647-0515
Mailing address:
  • Phone: 704-633-7220
  • Fax: 704-647-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2007-00803
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: