Individual
DR. SHYAMAL K MITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3280 HENDERSON DR STE C, JACKSONVILLE, NC 28546-5290
(910) 915-8450
(888) 745-7026
Mailing address
3280 HENDERSON DR STE C, JACKSONVILLE, NC 28546-5290
(910) 915-8450
(888) 745-7026
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0035439
NC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
00-35439
NC
207U00000X
Nuclear Medicine Physician
0035439
NC
207UN0901X
Nuclear Cardiology Physician
0035439
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060030036
RAILROAD MEDICARE
—
01
—
59825
BCBS OF NC
NC
05
—
8959825
—
NC
Enumeration date
12/07/2005
Last updated
08/02/2023
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