Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 26531 | NC |
N | 111NI0900X | Internist | 26531 | NC |
Y | 207RG0300X | Geriatric Medicine | 26531 | NC |
NPI | 1063587095 |
---|---|
Provider Name | Dr. Shyam Lal Garg |
First Address | Hampstead, NC 28443-3390 |
Second Address | Hampstead, NC 28443-3390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34555 | BLUE CROSS BLUE SHIELD (01) | NC |
8934555 | (05) | NC |
C81646 | (02) | NC |