Provider Demographics
NPI:1528024528
Name:CHUDASAMA, LAXMIKANT HARJIVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAXMIKANT
Middle Name:HARJIVAN
Last Name:CHUDASAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:LAX
Other - Middle Name:H
Other - Last Name:CHUDASAMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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
Is Sole Proprietor?:No
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?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA036640OtherBCBSOF VA
NC22509OtherBCBS OF NC
NC21628OtherWELLPATH
NC5901902Medicaid
NC0480074OtherUNITED HEALTHCARE
NC207003OtherCIGNA
NC21628OtherWELLPATH
VA036640OtherBCBSOF VA