Provider Demographics
NPI:1528226321
Name:GAVIN, NEHA SHARDUL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:SHARDUL
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:SHARDUL
Other - Last Name:VIBHAKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 N LEBANON ST STE 265
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8621
Practice Address - Country:US
Practice Address - Phone:765-485-8830
Practice Address - Fax:765-485-8789
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066631A207RE0101X
IN0106631A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201088770Medicaid