Healthcare Provider Details

I. General information

NPI: 1710621982
Provider Name (Legal Business Name): NITIN PURUSHOTTAM JOGLEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date: 01/27/2023
Reactivation Date: 04/13/2023

III. Provider practice location address

850 W OLIVE AVE
MERCED CA
95348-2427
US

IV. Provider business mailing address

850 W OLIVE AVE
MERCED CA
95348-2427
US

V. Phone/Fax

Practice location:
  • Phone: 209-437-9410
  • Fax:
Mailing address:
  • Phone: 718-616-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA209284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: