Provider Demographics
NPI:1619067014
Name:KAMATH, ARVIND PANDURANG (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:PANDURANG
Last Name:KAMATH
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 1:1 MEDICAL PARK
Mailing Address - Street 2:KAMATH MEDICAL CLINIC MDPC
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3665
Mailing Address - Country:US
Mailing Address - Phone:334-756-5150
Mailing Address - Fax:334-756-6799
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3665
Practice Address - Country:US
Practice Address - Phone:334-756-5150
Practice Address - Fax:334-756-6799
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7743207R00000X
GA33846207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000170068DMedicaid
AL51548132OtherBCBS
AL100734Medicaid
AL51548132OtherBCBS
GA000170068DMedicaid