Provider Demographics
NPI:1003911751
Name:WADHWANI, BHAGWAN J (MD)
Entity Type:Individual
Prefix:MR
First Name:BHAGWAN
Middle Name:J
Last Name:WADHWANI
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 1:129 SIMPSON ROAD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417
Mailing Address - Country:US
Mailing Address - Phone:724-785-2330
Mailing Address - Fax:724-785-2330
Practice Address - Street 1:129 SIMPSON ROAD
Practice Address - Street 2:SUITE #102
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417
Practice Address - Country:US
Practice Address - Phone:724-785-2330
Practice Address - Fax:724-785-2330
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030604L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018637Medicare PIN