Provider Demographics
NPI:1134188543
Name:WADHAVKAR, GEETANJALI JULIE (MD)
Entity type:Individual
Prefix:
First Name:GEETANJALI
Middle Name:JULIE
Last Name:WADHAVKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEETANJALI
Other - Middle Name:MANOJ
Other - Last Name:WADHAVKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:925-875-6100
Mailing Address - Fax:
Practice Address - Street 1:4050 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:925-875-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053078207R00000X
CAA65929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKV0854893203OtherCAREFIRST
MD032650000Medicaid
DCW6200030OtherCAREFIRST
G66515Medicare UPIN
MDK519I117Medicare PIN