Provider Demographics
NPI:1780975128
Name:BAGDURE, VANITA SATISH (MD)
Entity type:Individual
Prefix:MRS
First Name:VANITA
Middle Name:SATISH
Last Name:BAGDURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:931 STATE HWY 121
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:469-649-9995
Mailing Address - Fax:469-649-8759
Practice Address - Street 1:931 STATE HWY 121
Practice Address - Street 2:SUITE 4300
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:469-649-9995
Practice Address - Fax:469-649-8759
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK30302207R00000X, 208M00000X
TX3032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist