Healthcare Provider Details

I. General information

NPI: 1346329133
Provider Name (Legal Business Name): JWALANT VADALIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 WEBSTER STREET
MANCHESTER NH
03104
US

IV. Provider business mailing address

PO BOX 3300
MANCHESTER NH
03105
US

V. Phone/Fax

Practice location:
  • Phone: 603-645-5977
  • Fax: 603-645-5980
Mailing address:
  • Phone: 603-645-5977
  • Fax: 603-645-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JWALANT K VADALIA
Title or Position: PRESIDENT
Credential: MD
Phone: 603-645-5977