Provider Demographics
NPI:1003850322
Name:JINDAL, PRITI V (MD)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:V
Last Name:JINDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7677
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-7677
Mailing Address - Country:US
Mailing Address - Phone:812-260-1394
Mailing Address - Fax:812-269-5214
Practice Address - Street 1:240 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2311
Practice Address - Country:US
Practice Address - Phone:812-360-3381
Practice Address - Fax:812-269-5214
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075098A207R00000X
GA90588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186731901Medicaid
TX186731903Medicaid
TX186731902Medicaid
TX186731904Medicaid
TX8L2189Medicare PIN
TX186731901Medicaid
TX186731902Medicaid
TXTXB154851Medicare PIN
TXP00311182Medicare PIN