Provider Demographics
NPI:1700929817
Name:KANDL, LOUIS CHARLES (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:CHARLES
Last Name:KANDL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3904
Mailing Address - Country:US
Mailing Address - Phone:704-982-2189
Mailing Address - Fax:
Practice Address - Street 1:331 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3904
Practice Address - Country:US
Practice Address - Phone:704-982-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202360EOtherMEDICARE PIN, WILKES LOCATION
NC8947783Medicaid
NCNC4277AOtherMEDICARE PTAN, INDIVIDUAL FOR WILKES NETWORK
NC47783OtherBCBS OF NC
NC202360DOtherMEDICARE PIN, STANLY LOCATION
NC2335816OtherMEDICARE PTAN, CAROLINAS HOSPITALIST GROUP-WILKES
NC202360DOtherMEDICARE PIN, STANLY LOCATION
NC47783OtherBCBS OF NC