Provider Demographics
NPI:1063155117
Name:JAGANNATHAN, PRIYANKA (MD, MBA)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:JAGANNATHAN
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TRINITY ST
Mailing Address - Street 2:HEALTH DISCOVERY BLDG, STOP Z0090
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1869
Mailing Address - Country:US
Mailing Address - Phone:512-324-7000
Mailing Address - Fax:
Practice Address - Street 1:1701 TRINITY ST
Practice Address - Street 2:HEALTH DISCOVERY BLDG, STOP Z0090
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1869
Practice Address - Country:US
Practice Address - Phone:512-324-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10079240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine