Provider Demographics
NPI:1730110669
Name:SEN, KAUSHIK (MD)
Entity Type:Individual
Prefix:
First Name:KAUSHIK
Middle Name:
Last Name:SEN
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 1:4117 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2121
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:2100 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8863207RX0202X
MN39216207RX0202X
NC2006-01327207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22406OtherNDBS #
ND319J0SEOtherMNBS #
ND22403OtherNDBS #
ND22602OtherNDBS #
ND12062Medicaid
ND721818400Medicaid
NDDA9011032520OtherPREFERRED ONE #
ND256J0SEOtherMNBS #
ND3600301OtherMEDICA #
NDND200217OtherLHS #
ND3600300OtherMEDICA #
ND22602OtherNDBS #
ND22403OtherNDBS #
ND721818400Medicaid
ND22406OtherNDBS #
NDG98074Medicare UPIN
ND22602Medicare ID - Type UnspecifiedND MEDICARE #
ND3600300OtherMEDICA #
NDND200217OtherLHS #