Provider Demographics
NPI:1497912604
Name:ZALAVADIA, KAJAL G (MD)
Entity Type:Individual
Prefix:DR
First Name:KAJAL
Middle Name:G
Last Name:ZALAVADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 GANSETT LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3694
Mailing Address - Country:US
Mailing Address - Phone:732-809-3284
Mailing Address - Fax:
Practice Address - Street 1:69 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5325
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:833-929-3520
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1992372403261QM2500X
NJ25MA11643800261QM2500X
NC2016-01492261QM2500X, 207RB0002X
NY319255261QM2500X
PAMD443258261QM2500X
NY1043889967261QM2500X
CT72803261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497912604Medicaid