Provider Demographics
NPI:1649238676
Name:NIGAM, MUKESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:KUMAR
Last Name:NIGAM
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 1:1114 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2936
Mailing Address - Country:US
Mailing Address - Phone:434-799-0183
Mailing Address - Fax:434-799-6829
Practice Address - Street 1:1114 MAIN STREET
Practice Address - Street 2:DANVILLE ANESTHESIOLOGISTS INC
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2936
Practice Address - Country:US
Practice Address - Phone:434-799-0183
Practice Address - Fax:434-799-6829
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233799207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA277983OtherANTHEM
VA5721130Medicaid
NC066EAOtherBCBS
NC89066EAMedicaid
VA5721130Medicaid
NC89066EAMedicaid