Provider Demographics
NPI:1104846047
Name:BAHIA, GURCHARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GURCHARAN
Middle Name:
Last Name:BAHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GURCHARAN
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21 ELY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1001
Mailing Address - Country:US
Mailing Address - Phone:315-445-8746
Mailing Address - Fax:315-445-8746
Practice Address - Street 1:21 ELY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1001
Practice Address - Country:US
Practice Address - Phone:315-445-8746
Practice Address - Fax:315-445-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167500-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G400000552Medicare PIN