MEDICARE: SANJAY A. PATWARDHAN, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	107804	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194783068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANJAY A. PATWARDHAN, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 952037
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-2037
Country	:	US
Telephone Number	:	636-566-8155
Fax Number	:	636-566-8732

Provider Business Practice Location Address
First Line	:	13610 BARRETT OFFICE DR
Second Line	:	SUITE 110
City	:	MANCHESTER
State	:	MO
Zip	:	63021-7816
Country	:	US
Telephone Number	:	314-909-4700
Fax Number	:	314-909-4712

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANJAY A PATWARDHAN
Credential	:	MD
Telephone Number	:	314-909-4700

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	11/24/2008

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