Basic Information
| Provider Information | |||||||||
| NPI: | 1164641783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALVI | ||||||||
| FirstName: | GAURI | ||||||||
| MiddleName: | RAHUL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GAIKWAD | ||||||||
| OtherFirstName: | GAURI | ||||||||
| OtherMiddleName: | VIJAY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D., PH.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 LIBERTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107393318 | ||||||||
| FaxNumber: | 9106713600 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LIBERTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107393318 | ||||||||
| FaxNumber: | 9106713600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | GETP.LSU.G02010.PD | LA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2007-01100 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 12673732 | 01 | NC | PHCS MULTIPLAN | OTHER | 1107248 | 01 | NC | COVENTRY NATIONAL - COVENTRY PPO | OTHER | 2813371 | 01 | NC | UNITED HEALTHCARE | OTHER | 1164641783 | 01 | NC | HUMANA | OTHER | 200774 | 01 | NC | MEDCOST LLC | OTHER | 9910070 | 01 | NC | AETNA | OTHER | 1164641783 | 01 | NC | HEALTHNET FEDERAL SERVICES | OTHER | 1164641783 | 05 | NC | MEDICAID | FH1101590 | 01 | NC | FIRST CAROLINA CARE | OTHER | 1164641783 | 01 | NC | DOCTORS DIRECT | OTHER | 868004 | 01 | NC | COVENTRY OF THE CAROLINAS | OTHER | 4048561 | 01 | NC | CIGNA GREATWEST | OTHER | 5907580 | 05 | NC | MEDICAID | 5907850 | 01 | NC | NC HEALTH CHOICE | OTHER | 1479H | 01 | NC | BLUECROSS BLUESHIELD | OTHER | 868004 | 01 | NC | WELLPATH | OTHER |