Provider Demographics
NPI:1578550232
Name:VADALIA, JWALANT K (MD)
Entity Type:Individual
Prefix:
First Name:JWALANT
Middle Name:K
Last Name:VADALIA
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:P.O. BOX 3300
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03105
Mailing Address - Country:US
Mailing Address - Phone:603-645-5977
Mailing Address - Fax:603-645-5980
Practice Address - Street 1:138 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-645-5977
Practice Address - Fax:603-645-5980
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH92032084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003103Medicaid
NH3071621Medicaid
0108830Y0NH01OtherANTHEM
NHRE3103Medicare ID - Type Unspecified