Individual
AMUDHAN JYOTHIDASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3634 CAPE CENTER DR, FAYETTEVILLE, NC 28304-4406
(910) 485-6470
Mailing address
3634 CAPE CENTER DR, FAYETTEVILLE, NC 28304-4406
(910) 485-6470
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
245539
MA
207RI0011X
Interventional Cardiology Physician
Primary
2017-01125
NC
207RI0011X
Interventional Cardiology Physician
96109
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
961093
—
SC
Enumeration date
08/18/2010
Last updated
03/26/2026
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