Provider Demographics
NPI:1588891022
Name:ALLEM, KAVITTA BAMAN (MD)
Entity type:Individual
Prefix:
First Name:KAVITTA
Middle Name:BAMAN
Last Name:ALLEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-704-5795
Mailing Address - Fax:
Practice Address - Street 1:10010 FALLS OF NEUSE RD STE 106
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8495
Practice Address - Country:US
Practice Address - Phone:919-235-6450
Practice Address - Fax:919-350-7204
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125319207RR0500X
NC2012-00472207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588891022Medicaid