Provider Demographics
NPI:1992751903
Name:KUNCHA, HARI KIRAN (MD)
Entity type:Individual
Prefix:
First Name:HARI
Middle Name:KIRAN
Last Name:KUNCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4267
Mailing Address - Country:US
Mailing Address - Phone:919-335-0911
Mailing Address - Fax:919-362-6911
Practice Address - Street 1:1051 PEMBERTON HILL RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4267
Practice Address - Country:US
Practice Address - Phone:919-335-0911
Practice Address - Fax:919-362-6911
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401089208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138TJOtherBCBS
NC89138TJMedicaid
NC2036467AMedicare PIN
NC138TJOtherBCBS
NCH21810Medicare UPIN
NC2036467Medicare PIN