Provider Demographics
NPI:1043303936
Name:BHARUCHA, JITENDRA BHAGWANDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:BHAGWANDAS
Last Name:BHARUCHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-332-4744
Mailing Address - Fax:203-333-4751
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5369
Practice Address - Country:US
Practice Address - Phone:203-332-4744
Practice Address - Fax:203-333-4751
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT022573208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38099Medicare UPIN