Provider Demographics
NPI:1114165008
Name:VADNERKAR, AMRUTA A (MD)
Entity Type:Individual
Prefix:
First Name:AMRUTA
Middle Name:A
Last Name:VADNERKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NISHIGANDHA
Other - Middle Name:K
Other - Last Name:SOLEGAONKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2020 E WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7339
Mailing Address - Country:US
Mailing Address - Phone:480-730-5980
Mailing Address - Fax:
Practice Address - Street 1:2020 E WOODSIDE CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7339
Practice Address - Country:US
Practice Address - Phone:480-730-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435809207RG0300X
AZ44931207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine