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General NPI Number Information
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NPI Number | 1487858916
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Entity Type | Individual
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Provider Name | PREMAL C. SANGHAVI MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 125 HOSPITAL CENTER BLVD SUITE 125
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City | STAFFORD
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State | VA
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Zip | 22554-6202
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Country | US
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Telephone | 540-741-7933
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Fax | 540-741-7934
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Provider Business Mailing Address
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Address Line | 125 OLDE GREENWICH DR SUITE 160
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-4001
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Country | US
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Telephone | 540-741-0544
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Fax | 540-741-0546
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101252518
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License Number State | VA
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