Provider Demographics
NPI:1487628657
Name:KANNAN, TAMILARASI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMILARASI
Middle Name:
Last Name:KANNAN
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1225
Mailing Address - Fax:704-384-1226
Practice Address - Street 1:8420 UNIVERSITY EXEC PARK DR STE 850
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1308
Practice Address - Country:US
Practice Address - Phone:704-384-1225
Practice Address - Fax:704-384-1226
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC894779AMedicaid
NC894779AMedicaid
NCF73487Medicare UPIN