Provider Demographics
NPI:1235143546
Name:NIGAM, GUNJAN (MD)
Entity Type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
Last Name:NIGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 TOWNE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8910
Mailing Address - Country:US
Mailing Address - Phone:919-460-2015
Mailing Address - Fax:919-460-2016
Practice Address - Street 1:256 TOWNE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8910
Practice Address - Country:US
Practice Address - Phone:919-460-2015
Practice Address - Fax:919-460-2016
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904669Medicaid
NC2055671Medicare PIN
NCP00682749Medicare PIN
NC5904669Medicaid
NC2055671AMedicare PIN