Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 036117885 | IL |
N | 207W00000X | Ophthalmologist | 200900397 | NC |
Y | 207WX0107X | Retina Specialist | 200900397 | NC |
NPI | 1023221199 |
---|---|
Provider Name | Sachin S Mudvari |
First Address | Raleigh, NC 27607-7513 |
Second Address | Raleigh, NC 27607-7513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 24/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036117885 | (05) | IL |
P00416350 | RRMC (01) | IL |