Provider Demographics
NPI:1740856988
Name:AMBADI, PRAGNA (MD)
Entity type:Individual
Prefix:
First Name:PRAGNA
Middle Name:
Last Name:AMBADI
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 1:1187 PATCHWORK FLDS
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4561
Mailing Address - Country:US
Mailing Address - Phone:314-327-5794
Mailing Address - Fax:
Practice Address - Street 1:1187 PATCHWORK FLDS
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-4561
Practice Address - Country:US
Practice Address - Phone:314-327-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021017908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine