Provider Demographics
NPI:1679570634
Name:LODHAVIA, DEVANG V (MD)
Entity type:Individual
Prefix:
First Name:DEVANG
Middle Name:V
Last Name:LODHAVIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3001
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0598
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:2 SHEPPARD RD
Practice Address - Street 2:UNIT 300
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4787
Practice Address - Country:US
Practice Address - Phone:856-424-7390
Practice Address - Fax:856-424-7386
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09049800207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00310460OtherMEDICARE RAILROAD
LA1165743Medicaid
LAH95742Medicare UPIN
LA4F551Medicare PIN