Provider Demographics
NPI:1740274844
Name:ALATAR, KIRA MARK (MD)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:MARK
Last Name:ALATAR
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-815-2882
Practice Address - Street 1:9101 OCEAN HWY E
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7867
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2019-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9800763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC791096RMedicaid
NC791096RMedicaid
G22967Medicare UPIN