Provider Demographics
NPI:1538120233
Name:TRIVEDI, KANHAIYALAL TAPISHANKAR (MD)
Entity Type:Individual
Prefix:MR
First Name:KANHAIYALAL
Middle Name:TAPISHANKAR
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5900
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:7547 MEDICAL DR # 1300
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4351
Practice Address - Country:US
Practice Address - Phone:804-695-8550
Practice Address - Fax:804-695-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL277422084N0400X
GA0508472084N0400X
VA01012485472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL123251Medicaid
AL102I131155Medicare PIN