Healthcare Provider Details

I. General information

NPI: 1760484299
Provider Name (Legal Business Name): BHAVANI LAGADAPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LATTNER CT SUITE 100
MORRISVILLE NC
27560-6843
US

IV. Provider business mailing address

2501 ATRIUM DR SUITE 305
RALEIGH NC
27607-6452
US

V. Phone/Fax

Practice location:
  • Phone: 919-297-0348
  • Fax: 919-297-0349
Mailing address:
  • Phone: 919-297-0348
  • Fax: 919-297-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007-01007
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: