Healthcare Provider Details

I. General information

NPI: 1639638976
Provider Name (Legal Business Name): ANGADPAL S BATRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 10/05/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SULAGER 301
VILSECK BAYERN
92249
DE

IV. Provider business mailing address

CMR 411 BOX 260
APO AE
09112-0003
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2432
  • Fax:
Mailing address:
  • Phone: 314-590-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number33307
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33307
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: