Provider Demographics
NPI:1114029329
Name:BHADURI, ADITI (MD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:BHADURI
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 1:3021 VITTORIA LOOP
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2576
Mailing Address - Country:US
Mailing Address - Phone:209-566-0029
Mailing Address - Fax:
Practice Address - Street 1:2510 DOUGLAS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3302
Practice Address - Country:US
Practice Address - Phone:916-746-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55649207RE0101X
GA045852207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC55649OtherMEDICAL LICENSE
GAG87519Medicare UPIN
CAC55649OtherMEDICAL LICENSE