Provider Demographics
NPI:1518938521
Name:TUMBAPURA, ANIL PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:PRAKASH
Last Name:TUMBAPURA
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 1:2513 BELDEN PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7405
Mailing Address - Country:US
Mailing Address - Phone:919-413-7091
Mailing Address - Fax:
Practice Address - Street 1:2600 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1502
Practice Address - Country:US
Practice Address - Phone:919-881-9999
Practice Address - Fax:919-881-9998
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132KJMedicaid
NC89132KJMedicaid
NCH10192Medicare UPIN