Provider Demographics
NPI:1750531786
Name:TALWAR, DEVINA (MD)
Entity type:Individual
Prefix:
First Name:DEVINA
Middle Name:
Last Name:TALWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 WILLIAMSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8192
Mailing Address - Country:US
Mailing Address - Phone:704-660-0321
Mailing Address - Fax:704-660-0765
Practice Address - Street 1:478 WILLIAMSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8192
Practice Address - Country:US
Practice Address - Phone:704-660-0321
Practice Address - Fax:704-660-0765
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC154UYOtherBCBS OF NC
NC5913746Medicaid
NC2075135Medicare PIN