Provider Demographics
NPI:1700873015
Name:AMARESH, AMAR M (MD)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:M
Last Name:AMARESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMARESHA
Other - Middle Name:
Other - Last Name:MUNIYAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5220 GREENS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4612
Mailing Address - Country:US
Mailing Address - Phone:919-781-1437
Mailing Address - Fax:919-503-4406
Practice Address - Street 1:5220 GREENS DAIRY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4612
Practice Address - Country:US
Practice Address - Phone:919-781-1437
Practice Address - Fax:919-503-4406
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006013372085R0202X, 2085R0204X
VA01012783902085R0202X
SC893322085R0202X
TXT37342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905238Medicaid
H68030Medicare UPIN
NC2059998Medicare PIN