Provider Demographics
NPI:1578208757
Name:GAJJAR, PRACHI CHETANKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:CHETANKUMAR
Last Name:GAJJAR
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 1:1350 EAST MARKET STREET, WESTERN RESERVE HEALTH EDUCATI
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 EAST MARKET STREET, WESTERN RESERVE HEALTH EDUCATI
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-675-5714
Practice Address - Fax:330-675-5721
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program