Provider Demographics
NPI:1376509372
Name:LAX H. CHUDASAMA, M.D.P.C.
Entity Type:Organization
Organization Name:LAX H. CHUDASAMA, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAXMIKANT
Authorized Official - Middle Name:HARJIVAN
Authorized Official - Last Name:CHUDASAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:919-277-0491
Mailing Address - Street 1:3820 BLAND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6239
Mailing Address - Country:US
Mailing Address - Phone:919-277-0491
Mailing Address - Fax:919-277-0493
Practice Address - Street 1:3820 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6239
Practice Address - Country:US
Practice Address - Phone:919-277-0491
Practice Address - Fax:919-277-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901902Medicaid
NC0480074OtherUNITED HEALTHCARE
VA036640OtherBCBS OF VIRGINIA
NC21628OtherWELLPATH
NC22509OtherBCBS OF N.C.
NC207003OtherCIGNA
NC207003OtherCIGNA
NC2175874Medicare PIN