Provider Demographics
NPI:1639638976
Name:BATRA, ANGADPAL S
Entity Type:Individual
Prefix:
First Name:ANGADPAL
Middle Name:S
Last Name:BATRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 411 BOX 260
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0003
Mailing Address - Country:US
Mailing Address - Phone:314-590-2432
Mailing Address - Fax:
Practice Address - Street 1:SULAGER 301
Practice Address - Street 2:
Practice Address - City:VILSECK
Practice Address - State:BAYERN
Practice Address - Zip Code:92249
Practice Address - Country:DE
Practice Address - Phone:314-590-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33307208D00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program