Provider Demographics
NPI:1437126224
Name:DEV, GAUTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:
Last Name:DEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1205 CAPE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4404
Mailing Address - Country:US
Mailing Address - Phone:910-678-8611
Mailing Address - Fax:910-678-8100
Practice Address - Street 1:1205 CAPE CT
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4404
Practice Address - Country:US
Practice Address - Phone:910-678-8611
Practice Address - Fax:910-678-8100
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9501525207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928412Medicaid
NC0134JOtherBLUE CROSS
NC8928412Medicaid
NC2219112EMedicare PIN