Provider Demographics
NPI:1396788188
Name:KAMDAR, MUKESH NAUTAM (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:NAUTAM
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 1:4201 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7512
Mailing Address - Country:US
Mailing Address - Phone:919-785-0384
Mailing Address - Fax:919-785-0038
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-785-0384
Practice Address - Fax:919-785-0038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC381052084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7947786Medicaid
NCMA891193GMedicaid
NC7947786Medicaid
NC2152123Medicare PIN
NC2152123CMedicare PIN