Provider Demographics
NPI:1801113527
Name:VILASAGAR, SMITHA (MD)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:VILASAGAR
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 1:6700 FAIRVIEW RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3324
Mailing Address - Country:US
Mailing Address - Phone:704-200-9805
Mailing Address - Fax:
Practice Address - Street 1:6700 FAIRVIEW RD STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3324
Practice Address - Country:US
Practice Address - Phone:704-200-9805
Practice Address - Fax:833-909-3961
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01148207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2841Medicaid
NC1801113527Medicaid
NC1801113527Medicaid