Provider Demographics
NPI:1295908440
Name:MADAN LAL M.D. P.A.
Entity type:Organization
Organization Name:MADAN LAL M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-3108
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0239
Mailing Address - Country:US
Mailing Address - Phone:919-934-3108
Mailing Address - Fax:
Practice Address - Street 1:925 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4357
Practice Address - Country:US
Practice Address - Phone:919-934-3108
Practice Address - Fax:919-938-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26839332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7950626Medicaid
NC202830Medicare PIN
NC0807500001Medicare NSC