Provider Demographics
NPI:1114937646
Name:BRAR, INDERJEET (MD)
Entity Type:Individual
Prefix:
First Name:INDERJEET
Middle Name:
Last Name:BRAR
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 1:4881 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1867
Mailing Address - Country:US
Mailing Address - Phone:330-294-4440
Mailing Address - Fax:330-236-4960
Practice Address - Street 1:875 8TH ST NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8503
Practice Address - Country:US
Practice Address - Phone:330-294-4440
Practice Address - Fax:330-236-4960
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083555207R00000X, 208M00000X
CAC155922207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2549791Medicaid
OH2549791Medicaid
OH4150802Medicare PIN