Provider Demographics
NPI:1538336250
Name:LALL, BHAVNA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:BHAVNA
Middle Name:
Last Name:LALL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 5910
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-4430
Mailing Address - Fax:
Practice Address - Street 1:HEALTH 2, 4349 MARTIN LUTHER KING BLVD SUITE 1001E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-1407
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249265207R00000X
TXS7705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty