Prashant Balwant Bagalkotkar, MD
Individual provider Active NPI Family Medicine Physician · Fort Eustis, VA
NPI 1639168784 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1639168784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101049685 (VA)
- Practice address
- 576 Sternberg Ave
Fort Eustis, VA 23604-1527 - Phone
- (757) 314-7887
- NPI assigned
- Oct 20, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170130001705 | VA | Order and Referring Only - Family Practice |
8325228869 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101049685 | VA | Yes |
Addresses
Primary practice location
576 Sternberg Ave
Fort Eustis, VA 23604-1527
Mailing address
576 Sternberg Ave
Fort Eustis, VA 23604-1527
Phone (757) 314-7682
Other providers in Fort Eustis, VA
- Ahc McDonald-Eustis
- Ahc McDonald-Eustis
- Shane Aiken
- Carolyn Armstrong Alexander
- George David Altmann
- Leona Renee Bahamon
- Mostafa H Bakir
- Lisa Annette Barber
- Marc Allan Barrett
- Marie Barrett
All providers in Fort Eustis, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.