Provider Demographics
NPI:1083905061
Name:SHATAGOPAM, KARTIK (MD)
Entity Type:Individual
Prefix:MR
First Name:KARTIK
Middle Name:
Last Name:SHATAGOPAM
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9620
Mailing Address - Fax:704-633-7504
Practice Address - Street 1:401 MOCKSVILLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2735
Practice Address - Country:US
Practice Address - Phone:704-633-9620
Practice Address - Fax:704-633-7504
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074384A207R00000X
NC2020-03525207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine