Healthcare Provider Details

I. General information

NPI: 1003042409
Provider Name (Legal Business Name): NIKHIL TEPPARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 LYNDHURST AVE
WINSTON SALEM NC
27103-4005
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-5221
  • Fax: 336-765-0430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAS2383278-0706
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2011-01276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: