Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01074384A | IN |
N | 111NI0900X | Internist | 01074384A | IN |
N | 207R00000X | Internist | 2020-03525 | NC |
N | 111NI0900X | Internist | 2020-03525 | NC |
Y | 207RI0011X | Interventional Cardiology | 2020-03525 | NC |
NPI | 1083905061 |
---|---|
Provider Name | Mr. Kartik Shatagopam |
First Address | Charlotte, NC 28260-0447 |
Second Address | Salisbury, NC 28144-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 26/10/2020 |