Provider Demographics
NPI:1942254891
Name:DELVADIA, RASIKLAL N (MD)
Entity Type:Individual
Prefix:DR
First Name:RASIKLAL
Middle Name:N
Last Name:DELVADIA
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 1:2185A CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-269-9800
Mailing Address - Fax:321-269-7082
Practice Address - Street 1:2185A CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-269-9800
Practice Address - Fax:321-269-7082
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0984865OtherCIGNA
18831OtherBLUE CROSS BLUE SHIELD
FL372670300Medicaid
169542OtherWELLCARE
18831OtherBLUE CROSS BLUE SHIELD
F41697Medicare UPIN