Healthcare Provider Details

I. General information

NPI: 1508845132
Provider Name (Legal Business Name): LAXMICHAND DEDHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SANDHILL DR STE 101
MIDDLETOWN DE
19709-5805
US

IV. Provider business mailing address

114 SANDHILL DR STE 101
MIDDLETOWN DE
19709-5805
US

V. Phone/Fax

Practice location:
  • Phone: 302-378-4779
  • Fax: 302-378-4789
Mailing address:
  • Phone: 302-378-4779
  • Fax: 302-378-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10004403
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: