Provider Demographics
NPI:1386269835
Name:MOIDEEN, PRAMILA PALLIKKAPPARA (MD)
Entity type:Individual
Prefix:
First Name:PRAMILA
Middle Name:PALLIKKAPPARA
Last Name:MOIDEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2552
Mailing Address - Country:US
Mailing Address - Phone:972-951-9599
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA UNIVERSITY MEDICAL CENTER ROOM BF-103-B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11961207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty