Provider Demographics
NPI:1033237110
Name:KYEREMATEN, GABRIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:A
Last Name:KYEREMATEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 BRERETON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1645
Mailing Address - Country:US
Mailing Address - Phone:919-737-9040
Mailing Address - Fax:919-715-4223
Practice Address - Street 1:1300 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2148
Practice Address - Country:US
Practice Address - Phone:919-733-0800
Practice Address - Fax:919-715-4223
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800084207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG53934Medicare UPIN
NCKY901298Medicare ID - Type Unspecified