Provider Demographics
NPI:1760484299
Name:LAGADAPATI, BHAVANI (MD)
Entity Type:Individual
Prefix:MRS
First Name:BHAVANI
Middle Name:
Last Name:LAGADAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 ATRIUM DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6452
Mailing Address - Country:US
Mailing Address - Phone:919-297-0348
Mailing Address - Fax:919-297-0349
Practice Address - Street 1:101 LATTNER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6843
Practice Address - Country:US
Practice Address - Phone:919-297-0348
Practice Address - Fax:919-297-0349
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01007207R00000X
KY38359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908009Medicaid
H95316Medicare UPIN
NC2074179AMedicare PIN