MEDICARE: PRADIP K DHAR MD

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	2080P0202X	Pediatric Cardiology Physician	L2222	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120265	OTHER	TX	SUPERIOR HEALTHPLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8H9854	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1699722108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRADIP K DHAR MD

Provider Business Mailing Address
First Line	:	5714 SPOHN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4116
Country	:	US
Telephone Number	:	361-561-0005
Fax Number	:	361-561-0006

Provider Business Practice Location Address
First Line	:	5714 SPOHN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4116
Country	:	US
Telephone Number	:	361-561-0005
Fax Number	:	361-561-0006

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	01/13/2023

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Directions to “ PRADIP K DHAR MD” Practice Location

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