Provider Demographics
NPI:1801866108
Name:KAVDE, UDAY S (MD)
Entity Type:Individual
Prefix:
First Name:UDAY
Middle Name:S
Last Name:KAVDE
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:PO BOX 20127
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0127
Mailing Address - Country:US
Mailing Address - Phone:919-571-1170
Mailing Address - Fax:919-783-7743
Practice Address - Street 1:3410 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7234
Practice Address - Country:US
Practice Address - Phone:919-571-1170
Practice Address - Fax:919-783-7743
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501295208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-47880Medicaid
NC2218801BMedicare ID - Type Unspecified
NC89-47880Medicaid