Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 94 00951 | NC |
NPI | 1861476848 |
---|---|
Provider Name | Shashi Kumar Nagaraj |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1074A | BCBS (01) | NC |
176874 | (05) | SC |
20848 | PARTNERS (01) | NC |
3000205000 | (05) | WV |
4645025 | AETNA (01) | NC |
6026176 | (05) | VA |
74321 | MEDCOST (01) | NC |
891074A | (05) | NC |
G02696 | (02) |