1659654465 NPI number — MINI BHASKAR MD LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659654465 NPI number — MINI BHASKAR MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINI BHASKAR MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659654465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6480
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3168 BRAVERTON ST
Provider Second Line Business Practice Location Address:
330
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037-2674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-956-3090
Provider Business Practice Location Address Fax Number:
410-956-3063
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BHASKAR
Authorized Official First Name:
MINI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
443-481-6464

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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