Provider Demographics
NPI:1982704169
Name:GOYAL, PRATIMA (MD)
Entity type:Individual
Prefix:
First Name:PRATIMA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:PRATIMA
Other - Middle Name:PRAKASH CHANDRA
Other - Last Name:CHOUDHARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:555 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3335
Mailing Address - Country:US
Mailing Address - Phone:203-359-4444
Mailing Address - Fax:203-323-3303
Practice Address - Street 1:555 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3335
Practice Address - Country:US
Practice Address - Phone:203-359-4444
Practice Address - Fax:203-323-3303
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54864207Q00000X
NY251872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33991Medicare UPIN