MEDICARE: DR. AMARNATH A KATHRESAL M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	MD.201123	LA
2	207RN0300X	Nephrology Physician	MD.201123	LA
3	207RN0300X	Nephrology Physician	2006-00720	NC

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

NPI Number	:	1033194402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMARNATH A KATHRESAL M.D.

Provider Business Mailing Address
First Line	:	4419 BEN FRANKLIN BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2147
Country	:	US
Telephone Number	:	919-477-3005
Fax Number	:	919-477-5526

Provider Business Practice Location Address
First Line	:	4419 BEN FRANKLIN BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2147
Country	:	US
Telephone Number	:	919-477-3005
Fax Number	:	919-477-5526

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/03/2009

4425 BEN FRANKLIN BLVD
DURHAM, NC
27704-2147

Practice Phone: 919-613-8432
Practice Fax: 919-668-5424

4419 BEN FRANKLIN BLVD
DURHAM, NC
27704-2147