DR. SHYAMAL K MITRA (NPI# 1467437079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467437079 |
| Entity Type | Individual |
| Full Name | DR. SHYAMAL K MITRA |
| Credential | MD |
| Practice Address |
260 Memorial Dr Ste A Jacksonville NC 28546-6332 |
| Mailing Address |
260 Memorial Dr Jacksonville NC 28546-6332 |
| Practice Telephone | 9109158450 |
| Practice Fax Number | 8887457026 |
| Mailing Telephone | 9109158450 |
| Mailing Fax Number | 8887457026 |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2019-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
0035439 | NC | Allopathic & Osteopathic Physicians |
| N | 207U00000X | Nuclear Medicine | 0035439 | NC | Allopathic & Osteopathic Physicians |
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
0035439 | NC | Allopathic & Osteopathic Physicians |
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
00-35439 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS OF NC | 59825 | 01 |
| NC | 8959825 | 05 | |
| RAILROAD MEDICARE | 060030036 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1136 Hwy 258 N Ste 102b, Kinston, NC 285048304 | 9109158450 | 8887457026 |
| Street Address |
260 MEMORIAL DR STE A |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407334105 | Jennifer Ficca Flinchum | Nurse Practitioner | 260 Memorial Dr Ste A, Jacksonville, NC 28546 | 2018-08-03 |
| 1033597067 | Onslow Sleep Clinic, LLC | Clinic/Center | 260 Memorial Dr Ste A, Jacksonville, NC 28546-6332 | 2015-05-11 |
| 1356622419 | David Ray Brown | Nurse Practitioner | 260 Memorial Dr Ste A, Jacksonville, NC 28546-6332 | 2011-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598182552 | Maedeh Ganji | Internal Medicine | 653 W 8th St # L-18, Jacksonville, FL 32209-6511 | 2014-03-27 |
| 1649696691 | Carolinaeast Physicians | Internal Medicine | 4725 Western Blvd, Jacksonville, NC 28546-6852 | 2014-03-14 |
| 1093151888 | Alejandro Pena Jr. | Internal Medicine | 14546 Old St Augustine Rd Suite 201, Jacksonville, FL 32258-2612 | 2013-05-20 |
| 1669696407 | Ruple Jayantilal Galani | Internal Medicine | 14546 Old Saint Augustine Rd Ste 103, Credentialing Department, Jacksonville, FL 32258-5469 | 2007-04-12 |
| 1154408656 | Heart Clinic of Jacksonville, LLC | Internal Medicine | 9551 Baymeadows Rd Ste 6, Jacksonville, FL 32256-7938 | 2006-11-01 |
| 1487757092 | Cardiovascular Associates of Jacksonville Pa | Internal Medicine | 3599 University Blvd South, Suite 913, Jacksonville, FL 32216-4269 | 2006-09-07 |
| 1316958838 | Valerie Mcnee | Internal Medicine | 1 Red Fox Ln, Jacksonville, AR 72076-2513 | 2006-08-10 |
| 1306895438 | Diagnostic Cardiology Pa | Internal Medicine | 6867 South Point Drive N, Suite 111, Jacksonville, FL 32216-8005 | 2006-05-08 |
| 1790743854 | Baptist Cardiology, Inc. | Internal Medicine | 1905 Corporate Square Blvd, Jacksonville, FL 32216-1940 | 2006-05-01 |
| 1386601896 | James C Campbell | Internal Medicine | 3225 University Blvd S Ste 104, Credentialing Department, Jacksonville, FL 32216-2757 | 2006-04-27 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on DR. SHYAMAL K MITRA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.