MEDICARE: DR. GHANSHYAM PRADYUMNA DWIVEDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	33230	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1033112602	OTHER	NC	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033112602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHANSHYAM PRADYUMNA DWIVEDI MD

Provider Business Mailing Address
First Line	:	1778 METROMEDICAL DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3861
Country	:	US
Telephone Number	:	910-483-4680
Fax Number	:	910-484-2704

Provider Business Practice Location Address
First Line	:	1778 METROMEDICAL DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3861
Country	:	US
Telephone Number	:	910-483-4680
Fax Number	:	910-484-2704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/09/2019

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