| Doctor Name: | DR. KAMAL PRASAD GAUTAM |
| NPI Number: | 1992053250 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MBBS |
| License Number: | 280518 |
| Business Practice Address: | 3045 East Ave Central Square, NY - 130362611 |
| Business Phone Number: | 3156681202 |
| Business Fax Number: | |
| Mailing Address: | 334 Forest Hill Dr, SYRACUSE |
| State: | NY |
| Postal Code: | 132063309 |
| Phone Number: | 3154403534 |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2012 |
| NPI Last Update Date: | 07/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0000X |
| License Number: | 280518 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | An internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |