Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 200100271 | NC |
NPI | 1023042215 |
---|---|
Provider Name | Dr. Kavita S Persaud |
First Address | Wilmington, NC 28409-2152 |
Second Address | Wilmington, NC 28403-4757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 13/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130FG | BCBS (01) | NC |
G24968 | (02) |