Provider Demographics
NPI:1629224092
Name:KAPUR, NEETI (MD)
Entity Type:Individual
Prefix:DR
First Name:NEETI
Middle Name:
Last Name:KAPUR
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 1:1095 N BRAGG BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3307
Mailing Address - Country:US
Mailing Address - Phone:910-568-5793
Mailing Address - Fax:910-758-8042
Practice Address - Street 1:1095 N BRAGG BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390
Practice Address - Country:US
Practice Address - Phone:910-568-5793
Practice Address - Fax:910-758-8042
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122618Medicaid
IL200757001Medicare PIN