Provider Demographics
NPI:1306848056
Name:MALPANI, SANJNA (MD)
Entity Type:Individual
Prefix:
First Name:SANJNA
Middle Name:
Last Name:MALPANI
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 1:890 E TRAVIS STREET
Mailing Address - Street 2:LA GRANGE VA OUTREACH CLINIC
Mailing Address - City:LAGRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945
Mailing Address - Country:US
Mailing Address - Phone:979-968-5878
Mailing Address - Fax:
Practice Address - Street 1:890 E TRAVIS STREET
Practice Address - Street 2:LA GRANGE VA OUTREACH CLINIC
Practice Address - City:LAGRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945
Practice Address - Country:US
Practice Address - Phone:979-968-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21085207Q00000X
TXN7941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3004560000Medicaid
MA411492Medicare ID - Type Unspecified
WV3004560000Medicaid