Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0035439 | NC |
N | 207RS0012X | Sleep Medicine | 00-35439 | NC |
N | 207U00000X | Nuclear Medicine Specialist | 0035439 | NC |
NPI | 1467437079 |
---|---|
Provider Name | Dr. Shyamal K Mitra |
First Address | Jacksonville, NC 28546-6332 |
Second Address | Jacksonville, NC 28546-6332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 01/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060030036 | RAILROAD MEDICARE (01) | |
59825 | BCBS OF NC (01) | NC |
8959825 | (05) | NC |
E62936 | (02) |