MEDICARE: PRANJALI V GADGIL MBBS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487850228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANJALI V GADGIL MBBS

Provider Business Mailing Address
First Line	:	5600 BABCOCK RD
Second Line	:	APT 14208
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1811
Country	:	US
Telephone Number	:	210-548-0634
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 BABCOCK RD
Second Line	:	APT 14208
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1811
Country	:	US
Telephone Number	:	210-548-0634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	05/31/2012

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