Provider Demographics
NPI:1669450458
Name:TIWARI, SANDEEP KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KUMAR
Last Name:TIWARI
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 1:529 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3303
Mailing Address - Country:US
Mailing Address - Phone:252-537-6465
Mailing Address - Fax:252-535-0951
Practice Address - Street 1:529 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3303
Practice Address - Country:US
Practice Address - Phone:252-537-6465
Practice Address - Fax:252-535-0951
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1343WOtherNC MEDICAID PROVIDER #
NC891343WMedicaid
NC2003-00895OtherNC MEDICAL LICENSE #
NC3116888OtherMAMSI PROVIDER #
NCC9721OtherMEDCOST LLC PROVIDER #
NCC9721OtherMEDCOST LLC PROVIDER #
NC2019802BMedicare ID - Type UnspecifiedCIGNA MEDICARE #
NC1343WOtherNC MEDICAID PROVIDER #