Provider Demographics
NPI:1821038209
Name:KAKKAR, RAHUL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:KUMAR
Last Name:KAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAHUL
Other - Middle Name:KUMAR
Other - Last Name:KAKKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2911 BREEZEWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5464
Mailing Address - Country:US
Mailing Address - Phone:910-824-7619
Mailing Address - Fax:910-824-0773
Practice Address - Street 1:200 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5426
Practice Address - Country:US
Practice Address - Phone:910-824-7619
Practice Address - Fax:910-824-0773
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01905207R00000X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260310100Medicaid
NCFH2970520OtherFIRST CAROLINA CARE
SCQ01905OtherSC MEDICAID
NCFH2970520OtherFIRST MEDICARE DIRECT
NC18119OtherBCBS NC
NC7333509OtherAETNA
FL260310100Medicaid
NCFH2970520OtherFIRST MEDICARE DIRECT
SCQ01905OtherSC MEDICAID