Individual
SACHIN S MUDVARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4414 LAKE BOONE TRL, SUITE 302, RALEIGH, NC 27607-7513
(919) 782-8038
(919) 782-8189
Mailing address
4414 LAKE BOONE TRL, SUITE 302, RALEIGH, NC 27607-7513
(919) 782-8038
(919) 782-8189
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036117885
IL
207W00000X
Ophthalmology Physician
200900397
NC
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
200900397
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117885
—
IL
01
—
P00416350
RRMC
IL
Enumeration date
05/07/2007
Last updated
09/24/2020
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