Provider Demographics
NPI:1326060443
Name:LODHAVIA, PARAG JITENDRA (MD)
Entity Type:Individual
Prefix:
First Name:PARAG
Middle Name:JITENDRA
Last Name:LODHAVIA
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 1:302 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1818
Mailing Address - Country:US
Mailing Address - Phone:302-422-3393
Mailing Address - Fax:302-422-6875
Practice Address - Street 1:302 POLK AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1818
Practice Address - Country:US
Practice Address - Phone:302-422-3393
Practice Address - Fax:302-422-6875
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEI12123Medicare UPIN