Provider Demographics
NPI:1023042215
Name:PERSAUD, KAVITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:S
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6300 SHINNCREEK LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2152
Mailing Address - Country:US
Mailing Address - Phone:910-799-5508
Mailing Address - Fax:910-202-0654
Practice Address - Street 1:5919 OLEANDER DR STE 109
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4757
Practice Address - Country:US
Practice Address - Phone:910-799-5508
Practice Address - Fax:910-202-0654
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100271207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130FGOtherBCBS
G24968Medicare UPIN
NC2284563AMedicare PIN