Provider Demographics
NPI:1235286204
Name:HAMPSTEAD MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:HAMPSTEAD MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:LAL
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-270-2722
Mailing Address - Street 1:14980 US HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3390
Mailing Address - Country:US
Mailing Address - Phone:910-270-0282
Mailing Address - Fax:
Practice Address - Street 1:14980 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3390
Practice Address - Country:US
Practice Address - Phone:910-270-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26415207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34555OtherBC BS OF NORTH CAROLINA
NC8934555Medicaid
NCC81646Medicare UPIN
NC203074AMedicare ID - Type Unspecified