Provider Demographics
NPI:1033105739
Name:JOHN, JOHN KUNNUTHARA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KUNNUTHARA
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8800
Mailing Address - Country:US
Mailing Address - Phone:252-523-0026
Mailing Address - Fax:252-523-1855
Practice Address - Street 1:744 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:252-523-1855
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467405431OtherGROUP NPI
NC8901960OtherEASTERN CAROLINA PHYSICIANS GROUP MEDICAID NUMBER FOR KINSTON
NC1273POtherBCBS
NC5908296OtherEASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR BEULAVILLE
NC1033105739OtherINDIVIDUAL NPI
NC891273PMedicaid
NC8901960OtherEASTERN CAROLINA PHYSICIANS GROUP MEDICAID NUMBER FOR KINSTON
NC1033105739OtherINDIVIDUAL NPI