Provider Demographics
NPI:1033276811
Name:KASULA, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:KASULA
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 1:109 REDFERN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-412-3555
Mailing Address - Fax:
Practice Address - Street 1:155 PARKWAY OFFICE CT
Practice Address - Street 2:STE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7427
Practice Address - Country:US
Practice Address - Phone:919-852-3456
Practice Address - Fax:919-852-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC894785 AMedicaid
NC894785 AMedicaid