Provider Demographics
NPI:1467632521
Name:BHAGWANDIN, VIMLA PRAVENI (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIMLA
Middle Name:PRAVENI
Last Name:BHAGWANDIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6908 PROVIDENCE PARK DR S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4600
Mailing Address - Country:US
Mailing Address - Phone:251-660-3490
Mailing Address - Fax:251-660-3491
Practice Address - Street 1:6908 PROVIDENCE PARK DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4600
Practice Address - Country:US
Practice Address - Phone:251-660-3490
Practice Address - Fax:251-660-3491
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2018-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL28261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
515-45281OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL631500075Medicaid
AL510I37000OtherMEDICARE PECOS