Provider Demographics
NPI:1821222084
Name:JALANDHARA, PRIYANKA BACHUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:BACHUBHAI
Last Name:JALANDHARA
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 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:682-207-1030
Practice Address - Street 1:3025 N TARRANT PKWY STE 170
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177
Practice Address - Country:US
Practice Address - Phone:817-725-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055643207R00000X
MEMD20211207RR0500X
TXR1783207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine