Provider Demographics
NPI:1487815387
Name:ITALIA, HIRENKUMAR
Entity Type:Individual
Prefix:
First Name:HIRENKUMAR
Middle Name:
Last Name:ITALIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:980-487-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118308208M00000X
CODR.0061926208M00000X
WYTL5600208M00000X
NC2013-01926207Q00000X
DCMD047022208M00000X
TXS0695208M00000X
SD8986208M00000X
RIMD16621208M00000X
ORMD192450208M00000X
OK34461208M00000X
NMMD2011-0261208M00000X
MN57241208M00000X
MI4301117090208M00000X
IN01071167A208M00000X
IL36129919208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2007Medicaid
NC1487815387Medicaid
NC1487815387Medicaid
NCNCG654CMedicare PIN
NCNCG654EMedicare PIN
NCNCG654DMedicare PIN