Provider Demographics
NPI:1942280607
Name:GARG, KUSUM (MD)
Entity type:Individual
Prefix:
First Name:KUSUM
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2356 JOHN SMITH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2618
Mailing Address - Country:US
Mailing Address - Phone:910-920-1450
Mailing Address - Fax:910-920-1864
Practice Address - Street 1:2356 JOHN SMITH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2618
Practice Address - Country:US
Practice Address - Phone:910-920-1450
Practice Address - Fax:910-920-1864
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1200AOtherBCBS OF NC
NC891200AMedicaid
NC2271987CMedicare PIN
NC1200AOtherBCBS OF NC
NCG99418Medicare UPIN
NC2271987BMedicare PIN