Provider Demographics
NPI:1124212162
Name:LALITHA JAGADISH, M.D., P.A
Entity Type:Organization
Organization Name:LALITHA JAGADISH, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGADISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-4800
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-0646
Mailing Address - Country:US
Mailing Address - Phone:817-293-4800
Mailing Address - Fax:817-293-4808
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-4800
Practice Address - Fax:817-293-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty