Provider Demographics
NPI:1861476848
Name:NAGARAJ, SHASHI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:KUMAR
Last Name:NAGARAJ
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 1:2100 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
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:2005-12-02
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94 009512080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3000205000Medicaid
NC74321OtherMEDCOST
NC1074AOtherBCBS
SC176874Medicaid
NC20848OtherPARTNERS
NC4645025OtherAETNA
VA6026176Medicaid
NC891074AMedicaid
NC74321OtherMEDCOST
SC176874Medicaid
NC20848OtherPARTNERS
NC891074AMedicaid