Provider Demographics
NPI:1639168784
Name:BAGALKOTKAR, PRASHANT BALWANT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:BALWANT
Last Name:BAGALKOTKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 STERNBERG AVE
Mailing Address - Street 2:
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1527
Mailing Address - Country:US
Mailing Address - Phone:757-314-7682
Mailing Address - Fax:
Practice Address - Street 1:576 STERNBERG AVE
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1527
Practice Address - Country:US
Practice Address - Phone:757-314-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine