Provider Demographics
NPI:1770588428
Name:BANGDIWALA, DWEEPKUMAR I (MD)
Entity type:Individual
Prefix:
First Name:DWEEPKUMAR
Middle Name:I
Last Name:BANGDIWALA
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 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:STE 362
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-754-1535
Mailing Address - Fax:
Practice Address - Street 1:570 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3738
Practice Address - Country:US
Practice Address - Phone:787-754-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26677Medicare UPIN
PR97870Medicare ID - Type Unspecified