Provider Demographics
NPI:1407838014
Name:KUNDU, SARBA (MD)
Entity Type:Individual
Prefix:
First Name:SARBA
Middle Name:
Last Name:KUNDU
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 1:201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3490
Mailing Address - Country:US
Mailing Address - Phone:336-526-6195
Mailing Address - Fax:336-527-8379
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-3490
Practice Address - Country:US
Practice Address - Phone:336-526-6195
Practice Address - Fax:336-527-8379
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01105207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7338732OtherAETNA
WV3810003047Medicaid
NCE4472OtherMEDCOST
VA10179505Medicaid
NC806756OtherPARTNERS
NC139XGOtherBCBS
NC5902129Medicaid
I34399Medicare UPIN
NC5902129Medicaid
NCP00387754Medicare PIN