Provider Demographics
NPI:1184681553
Name:KIRIT D TRIVEDI MD PA
Entity Type:Organization
Organization Name:KIRIT D TRIVEDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT KIRIT D TRIVEDI MD PA
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRIT
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-438-7102
Mailing Address - Street 1:568 RUIN CREEK ROAD
Mailing Address - Street 2:SUITE 001
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-438-7102
Mailing Address - Fax:252-438-7102
Practice Address - Street 1:568 RUIN CREEK ROAD
Practice Address - Street 2:SUITE 001
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-438-7102
Practice Address - Fax:252-438-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0142QOtherBC BS
432389OtherANTHEM BC BS
NC890142QMedicaid
C80838Medicare UPIN
0142QOtherBC BS