Provider Demographics
NPI:1437177474
Name:KERSTEN, BRIAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:KERSTEN
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15110 JOHN J DELANEY DR
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3544
Practice Address - Country:US
Practice Address - Phone:704-302-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134M6OtherBLUE CROSS BLUE SHIELD
NC1437177474Medicaid
SCN0013BMedicaid
SCN00132Medicaid
NC89134M6Medicaid
SCN0013BMedicaid
NC2019471CMedicare PIN
NC2019471BMedicare PIN
NC89134M6Medicaid
NC2019471AMedicare PIN