Provider Demographics
NPI:1255400321
Name:DALVI, SUMEDHA SANJIV (MD)
Entity type:Individual
Prefix:DR
First Name:SUMEDHA
Middle Name:SANJIV
Last Name:DALVI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:5085 MORGANTON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1497
Mailing Address - Country:US
Mailing Address - Phone:910-864-0689
Mailing Address - Fax:910-864-3747
Practice Address - Street 1:5085 MORGANTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1497
Practice Address - Country:US
Practice Address - Phone:910-864-0689
Practice Address - Fax:910-864-3747
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC861015XMedicaid
NC432024077OtherTAX ID
NC432024077OtherTAX ID
NCG67947Medicare UPIN