Healthcare Provider Details

I. General information

NPI: 1710365614
Provider Name (Legal Business Name): ANSHUL BADHWAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/17/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BON AIR RD STE 100
LARKSPUR CA
94939-1144
US

IV. Provider business mailing address

2 BON AIR RD STE 100
LARKSPUR CA
94939-1144
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-0666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number312447
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA181177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: