MEDICARE: DR. KAUSTUBH CHANDRASHEKHAR DABHADKAR

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	2017-00330	NC
2	207RC0000X	Cardiovascular Disease Physician	2017-00330	NC

General Provider Information

NPI Number	:	1932498581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAUSTUBH CHANDRASHEKHAR DABHADKAR

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-3024
Fax Number	:	980-302-2110

Provider Business Practice Location Address
First Line	:	8201 HEALTHCARE LOOP STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-7072
Country	:	US
Telephone Number	:	704-316-3024
Fax Number	:	980-302-2110

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	08/25/2023

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