Provider Demographics
NPI:1144227638
Name:GATIWALA, INDRAVADAN SAKARLAL (MD)
Entity Type:Individual
Prefix:MR
First Name:INDRAVADAN
Middle Name:SAKARLAL
Last Name:GATIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2325
Mailing Address - Country:US
Mailing Address - Phone:910-739-2343
Mailing Address - Fax:910-739-2338
Practice Address - Street 1:785 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2325
Practice Address - Country:US
Practice Address - Phone:910-739-2343
Practice Address - Fax:910-739-2338
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0096009192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934955Medicaid
NC2226556AMedicare ID - Type Unspecified
NC8934955Medicaid