Healthcare Provider Details

I. General information

NPI: 1275712499
Provider Name (Legal Business Name): PRAGATHI SALIGRAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ELISEO DR
GREENBRAE CA
94904-2134
US

IV. Provider business mailing address

900 S ELISEO DR
GREENBRAE CA
94904-2134
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-1780
  • Fax:
Mailing address:
  • Phone: 415-461-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number246398
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246398
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number233139
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA126377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: