Provider Demographics
NPI:1023122074
Name:KANTESARIA, ATUL NANDLAL (MD)
Entity type:Individual
Prefix:DR
First Name:ATUL
Middle Name:NANDLAL
Last Name:KANTESARIA
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 1:4310 HUNTSFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-485-4248
Mailing Address - Fax:910-491-0002
Practice Address - Street 1:105 HUNTER CIRCLE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-433-4463
Practice Address - Fax:910-491-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94014272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2213466DMedicare ID - Type Unspecified
F18180Medicare UPIN