Provider Demographics
NPI:1770573032
Name:RADHA J LAL MD PA
Entity type:Organization
Organization Name:RADHA J LAL MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA FACOG
Authorized Official - Phone:409-898-4454
Mailing Address - Street 1:3120 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1420
Mailing Address - Country:US
Mailing Address - Phone:409-898-4454
Mailing Address - Fax:409-898-4484
Practice Address - Street 1:3120 NORTH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1420
Practice Address - Country:US
Practice Address - Phone:409-898-4454
Practice Address - Fax:409-898-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0553207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TX00EB40Medicare ID - Type Unspecified
C18100Medicare UPIN