Provider Demographics
NPI:1508845132
Name:DEDHIA, LAXMICHAND (MD)
Entity Type:Individual
Prefix:DR
First Name:LAXMICHAND
Middle Name:
Last Name:DEDHIA
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 1:114 SANDHILL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5805
Mailing Address - Country:US
Mailing Address - Phone:302-378-4779
Mailing Address - Fax:302-378-4789
Practice Address - Street 1:114 SANDHILL DR
Practice Address - Street 2:STE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5805
Practice Address - Country:US
Practice Address - Phone:302-378-4779
Practice Address - Fax:302-378-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10004403OtherDE STATE LICENCE NO.
DE0000587501Medicaid
DEC10004403OtherDE STATE LICENCE NO.
DE0000587501Medicaid