Healthcare Provider Details

I. General information

NPI: 1497912604
Provider Name (Legal Business Name): KAJAL G ZALAVADIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 GROVE ST
NEW CANAAN CT
06840-5325
US

IV. Provider business mailing address

5109 GANSETT LN
RALEIGH NC
27612-3694
US

V. Phone/Fax

Practice location:
  • Phone: 844-359-8363
  • Fax: 833-929-3520
Mailing address:
  • Phone: 732-809-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1992372403
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA11643800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2016-01492
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number319255
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD443258
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1043889967
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number72803
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number2016-01492
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: