MEDICARE: SHIVESH KUMAR VERMA M.D.

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	207Q00000X	Family Medicine Physician	MD60984958	WA
2	207Q00000X	Family Medicine Physician	2026-01772	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1609238708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVESH KUMAR VERMA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	980-302-3550
Fax Number	:	980-302-3551

Provider Business Practice Location Address
First Line	:	11300 CRESTHILL DR STE 100
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-7992
Country	:	US
Telephone Number	:	980-302-3550
Fax Number	:	980-302-3551

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	06/11/2026

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