Provider Demographics
NPI:1114018454
Name:BHARMAL, AMBAREEN A (MD)
Entity Type:Individual
Prefix:
First Name:AMBAREEN
Middle Name:A
Last Name:BHARMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 N MEADOWS DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2546
Mailing Address - Country:US
Mailing Address - Phone:614-875-3592
Mailing Address - Fax:614-875-8258
Practice Address - Street 1:5350 N MEADOWS DR
Practice Address - Street 2:SUITE 160
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2546
Practice Address - Country:US
Practice Address - Phone:614-875-3592
Practice Address - Fax:614-875-8258
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008017207Q00000X
NY247240-1207Q00000X
OH35-123631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041375Medicaid
NY00695941Medicaid
NY00695941Medicaid
NY331946Medicare PIN
DE1000041375Medicaid
NY331946Medicare PIN