Healthcare Provider Details

I. General information

NPI: 1215292875
Provider Name (Legal Business Name): AMRITA ANIL WAINGANKAR M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 O CONNOR DR APT 2502
ROUND ROCK TX
78681
US

IV. Provider business mailing address

7711 OCONNOR DR APT 2502
ROUND ROCK TX
78681-5574
US

V. Phone/Fax

Practice location:
  • Phone: 512-520-9125
  • Fax:
Mailing address:
  • Phone: 512-520-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberP1606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: