Provider Demographics
NPI:1003878737
Name:GUJJAR, PRIYAMVADA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYAMVADA
Middle Name:
Last Name:GUJJAR
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 1:4510 CALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-5600
Mailing Address - Country:US
Mailing Address - Phone:863-385-3333
Mailing Address - Fax:
Practice Address - Street 1:4510 CALOOSA CT
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-5600
Practice Address - Country:US
Practice Address - Phone:863-385-5129
Practice Address - Fax:863-385-7162
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90078Medicare UPIN
FL71659Medicare ID - Type Unspecified