Provider Demographics
NPI:1053390310
Name:NIGAM, PRONOTI (MD)
Entity type:Individual
Prefix:MRS
First Name:PRONOTI
Middle Name:
Last Name:NIGAM
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 1:4205 SAN FELIPE RD
Mailing Address - Street 2:#110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1503
Mailing Address - Country:US
Mailing Address - Phone:408-238-8303
Mailing Address - Fax:408-238-8375
Practice Address - Street 1:4205 SAN FELIPE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1503
Practice Address - Country:US
Practice Address - Phone:408-238-8303
Practice Address - Fax:408-238-8375
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C431251Medicare ID - Type Unspecified
F74646Medicare UPIN