Provider Demographics
NPI:1215986807
Name:DALAWARI, JASDEEP S (MD)
Entity type:Individual
Prefix:
First Name:JASDEEP
Middle Name:S
Last Name:DALAWARI
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 1:1858 GREY OAKS PARK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5798
Mailing Address - Country:US
Mailing Address - Phone:918-699-9525
Mailing Address - Fax:
Practice Address - Street 1:CMG STROOBANTS CARDIOVASCULAR CENTER LYNCHBURG
Practice Address - Street 2:2410 ATHERHOLT ROAD
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2148
Practice Address - Country:US
Practice Address - Phone:434-200-5252
Practice Address - Fax:434-200-2851
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237240207P00000X, 207RC0000X
IL036142259207P00000X, 207R00000X, 207RC0000X
WI2477207RC0000X, 207RI0011X
IDMC-1386207RI0011X
WI2477-320207RC0000X
WV29785207RI0011X
IL036.142259207RI0011X
KY50655207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00803509OtherRAILROAD MEDICARE TO GRP DN7755
H54593Medicare UPIN
VAVVC211AMedicare PIN
VA010197546Medicaid
VA012132V68Medicare PIN
VA008659V20Medicare PIN
VA008514V67Medicare PIN
FL1471QOtherBCBS
P00803509OtherRAILROAD MEDICARE TO GRP DN7755
FL'003208100Medicaid
VA010197911Medicaid
VA008287V21Medicare PIN
FLCR130ZMedicare PIN
H54593Medicare UPIN
VA010197783Medicaid
VA010197511Medicaid