Provider Demographics
NPI:1497071732
Name:DADVAND, LAILA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:DADVAND
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAUREL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3635
Mailing Address - Country:US
Mailing Address - Phone:856-455-4800
Mailing Address - Fax:856-451-0650
Practice Address - Street 1:201 LAUREL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3635
Practice Address - Country:US
Practice Address - Phone:856-455-4800
Practice Address - Fax:856-451-0650
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11700100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine