Provider Demographics
NPI:1235208018
Name:JAIN, KAMLA TERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMLA
Middle Name:TERESE
Last Name:JAIN
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:ASU STUDENT HEALTH CENTER
Mailing Address - Street 2:614 HOWARD STREET, MILES ANNAS BLDG
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608
Mailing Address - Country:US
Mailing Address - Phone:704-446-2360
Mailing Address - Fax:704-366-3746
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-446-2360
Practice Address - Fax:704-366-3746
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000471207Q00000X
NC2000-00471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6833648OtherCIGNA
NC8912545Medicaid
NC0106165OtherUNITED HEALTH CARE
NC12545OtherBLUE CROSS BLUE SHIELD
NC2279865KMedicare PIN
NC6833648OtherCIGNA
NC2279865DMedicare PIN
NC12545OtherBLUE CROSS BLUE SHIELD
NC0106165OtherUNITED HEALTH CARE
NCG49432Medicare UPIN
NC8912545Medicaid
NC2279865JMedicare PIN
NC2279865MMedicare PIN