Basic Information
| Provider Information | |||||||||
| NPI: | 1730148115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHALAVADI | ||||||||
| FirstName: | LAKSHMI | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 S SUTHERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042919267 | ||||||||
| FaxNumber: | 7042250428 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 S SUTHERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042919267 | ||||||||
| FaxNumber: | 7042250428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200201227 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89134VH | 05 | NC | MEDICAID |