Provider Demographics
NPI:1043395171
Name:DEOGUN, GURVINDER K (MD)
Entity Type:Individual
Prefix:
First Name:GURVINDER
Middle Name:K
Last Name:DEOGUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:10880 DURANT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6628
Practice Address - Country:US
Practice Address - Phone:919-846-0800
Practice Address - Fax:919-846-0880
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01170207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043395171Medicaid
NC202194BOtherMEDICARE PTAN
NCP00643305OtherRAILROAD MEDICARE
NC7202876OtherAETNA
NC5908675Medicaid