MEDICARE: MR. KANHAIYALAL TAPISHANKAR TRIVEDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	27742	AL
2	2084N0400X	Neurology Physician	050847	GA
3	2084N0400X	Neurology Physician	0101248547	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538120233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KANHAIYALAL TAPISHANKAR TRIVEDI MD

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD STE A
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-316-5900
Fax Number	:	757-534-5190

Provider Business Practice Location Address
First Line	:	7547 MEDICAL DR # 1300
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-4351
Country	:	US
Telephone Number	:	804-695-8550
Fax Number	:	804-695-8551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/21/2022

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