Healthcare Provider Details

I. General information

NPI: 1114564721
Provider Name (Legal Business Name): DADA BHAGWAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 HICKORY MEADOWS PL
GLEN ALLEN VA
23059-2653
US

IV. Provider business mailing address

PO BOX 31494
HENRICO VA
23294-1494
US

V. Phone/Fax

Practice location:
  • Phone: 804-514-6958
  • Fax: 804-282-9135
Mailing address:
  • Phone: 804-514-6958
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAURAVI H SANGHADIA
Title or Position: AUTHORIZED OFFICIAL/MEDICAL DOCTOR
Credential: MD
Phone: 804-514-6958