Provider Demographics
NPI:1043307762
Name:DALSANIA, NATVARLAL H (MD)
Entity Type:Individual
Prefix:
First Name:NATVARLAL
Middle Name:H
Last Name:DALSANIA
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:BREVARD COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:2575 N COURTENAY PKWY
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:BREVARD COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:2575 N COURTENAY PKWY
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-454-7148
Practice Address - Fax:321-449-5015
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050298208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064219300Medicaid
FL064219300Medicaid
FL04883AMedicare ID - Type Unspecified