Provider Demographics
NPI:1316595267
Name:GADHADE, MRINAL VILAS (PT)
Entity type:Individual
Prefix:
First Name:MRINAL
Middle Name:VILAS
Last Name:GADHADE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19785 CRYSTAL ROCK DR STE 309
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-4732
Mailing Address - Country:US
Mailing Address - Phone:240-724-6781
Mailing Address - Fax:888-607-7117
Practice Address - Street 1:19785 CRYSTAL ROCK DR STE 309
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-4732
Practice Address - Country:US
Practice Address - Phone:240-724-6781
Practice Address - Fax:888-607-7117
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist