Provider Demographics
NPI:1780871152
Name:ATUL KANTESARIA MD PLLC
Entity type:Organization
Organization Name:ATUL KANTESARIA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTESARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-433-4463
Mailing Address - Street 1:4310 HUNTSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2533
Mailing Address - Country:US
Mailing Address - Phone:910-584-5790
Mailing Address - Fax:910-491-0002
Practice Address - Street 1:105 HUNTER CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3407
Practice Address - Country:US
Practice Address - Phone:910-433-4463
Practice Address - Fax:910-491-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94014272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903692Medicaid
NCF18180Medicare UPIN