Individual
SANDEEP KUMAR TIWARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
529 BECKER DR, ROANOKE RAPIDS, NC 27870-3303
(252) 537-6465
(252) 535-0951
Mailing address
529 BECKER DR, ROANOKE RAPIDS, NC 27870-3303
(252) 537-6465
(252) 535-0951
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2003-00895
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1343W
NC MEDICAID PROVIDER #
NC
01
—
2003-00895
NC MEDICAL LICENSE #
NC
01
—
3116888
MAMSI PROVIDER #
NC
05
—
891343W
—
NC
01
—
C9721
MEDCOST LLC PROVIDER #
NC
Enumeration date
01/03/2006
Last updated
03/07/2023
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