Provider Demographics
NPI:1922280973
Name:KAMDAR, CIAMACK (MD)
Entity Type:Individual
Prefix:DR
First Name:CIAMACK
Middle Name:
Last Name:KAMDAR
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 1:9735 KINCEY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9120
Mailing Address - Country:US
Mailing Address - Phone:704-414-2870
Mailing Address - Fax:704-414-2860
Practice Address - Street 1:631 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3438
Practice Address - Country:US
Practice Address - Phone:704-864-7764
Practice Address - Fax:704-867-7894
Is Sole Proprietor?:No
Enumeration Date:2007-12-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101877208800000X
NC2009-00622208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912481Medicaid
NC2073668Medicare PIN