Provider Demographics
NPI:1598846743
Name:LODHIA, ANANT KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANANT
Middle Name:KUMAR
Last Name:LODHIA
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-7407
Mailing Address - Country:US
Mailing Address - Phone:916-436-9870
Mailing Address - Fax:916-966-0213
Practice Address - Street 1:4635 COLLEGE OAK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4516
Practice Address - Country:US
Practice Address - Phone:916-436-9870
Practice Address - Fax:916-966-0213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0049470Medicaid
CAZZZ26869ZOtherMEDICARE GROUP PTAN
CAZZZ26869ZOtherMEDICARE GROUP PTAN
CAA46526Medicare UPIN