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General NPI Number Information
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NPI Number | 1104202175
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Entity Type | Individual
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Provider Name | CHARUDATTA WANKHADE MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 19 DAVIS AVE FL 6
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City | NEPTUNE
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State | NJ
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Zip | 07753-4488
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Country | US
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Telephone | 732-897-2777
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Fax | 732-897-3970
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5792
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Country | US
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Telephone | 732-807-0877
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Fax | 201-751-1680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D0091132
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA12603900
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License Number State | NJ
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