1306630678 NPI number — DR. PRAJWALA NAGARAJAPPA M.B.B.S

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306630678 NPI number — DR. PRAJWALA NAGARAJAPPA M.B.B.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGARAJAPPA
Provider First Name:
PRAJWALA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306630678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NO 1738 14TH MAIN ROAD
Provider Second Line Business Mailing Address:
SURYANAGARA PHASE 1
Provider Business Mailing Address City Name:
BANGALORE
Provider Business Mailing Address State Name:
KAMATAKA
Provider Business Mailing Address Postal Code:
560099
Provider Business Mailing Address Country Code:
IN
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE
Provider Second Line Business Practice Location Address:
64 MEDICAL CENTER DR
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-019-3526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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