Provider Demographics
NPI:1801870795
Name:KUKREJA, NEETA (MD)
Entity type:Individual
Prefix:
First Name:NEETA
Middle Name:
Last Name:KUKREJA
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 1:1636 LOOKOUT CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8085
Mailing Address - Country:US
Mailing Address - Phone:704-540-6860
Mailing Address - Fax:
Practice Address - Street 1:10410 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6568
Practice Address - Country:US
Practice Address - Phone:704-540-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics