Provider Demographics
NPI:1164628855
Name:KALAWADIA, VINODRAI (MD)
Entity Type:Individual
Prefix:
First Name:VINODRAI
Middle Name:
Last Name:KALAWADIA
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 1:212 OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2620
Mailing Address - Country:US
Mailing Address - Phone:215-699-3936
Mailing Address - Fax:
Practice Address - Street 1:212 OLD CHURCH RD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2620
Practice Address - Country:US
Practice Address - Phone:215-699-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038509L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001127980 0004Medicaid
NJP00861620OtherRR MEDICARE
NJP00861620OtherRR MEDICARE
PA001127980 0004Medicaid