Provider Demographics
NPI:1003801689
Name:BHANJA, UTPAL K (MD)
Entity Type:Individual
Prefix:
First Name:UTPAL
Middle Name:K
Last Name:BHANJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5000
Mailing Address - Fax:
Practice Address - Street 1:170 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1539
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-5622
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067633B207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100567180Medicaid
WV0076262001Medicaid
OH0996605Medicaid
OH0996605Medicaid
OH0996605Medicaid