Individual
PRATHIMA PANGULUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-5067
(585) 922-1399
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
276457
NY
208M00000X
Hospitalist Physician
Primary
276457
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01131126/RGH
—
NY
05
—
03001654/NWK
—
NY
Enumeration date
05/16/2011
Last updated
04/01/2019
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