Provider Demographics
NPI:1497804421
Name:KAPOOR, SUSHMA SURRINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:SURRINDER
Last Name:KAPOOR
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 1:6764 SURREY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2591
Mailing Address - Country:US
Mailing Address - Phone:910-425-9030
Mailing Address - Fax:
Practice Address - Street 1:1601 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-678-0100
Practice Address - Fax:910-678-0115
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28101207Q00000X
NC2010-01846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20045671OtherSELECT HEALTH
SC281019Medicaid
SC576001334002OtherBLUE CHOICE
SC576001334002OtherBLUE CROSS BLUE SHIELD
SC576001334007OtherCHAMPUS
SC281019Medicaid
SC576001334002OtherBLUE CHOICE
SCI44376Medicare UPIN