Provider Demographics
NPI:1114981503
Name:PUJARI, BHASKER R (MD)
Entity Type:Individual
Prefix:DR
First Name:BHASKER
Middle Name:R
Last Name:PUJARI
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 1:1333 SOUTHVIEW DR
Mailing Address - Street 2:P. O. BOX 1190
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4317
Mailing Address - Country:US
Mailing Address - Phone:304-327-3495
Mailing Address - Fax:
Practice Address - Street 1:1331 SOUTHVIEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4320
Practice Address - Country:US
Practice Address - Phone:304-327-3495
Practice Address - Fax:304-327-2989
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10308208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130730000Medicaid
D49210Medicare UPIN
WV7331421Medicare ID - Type Unspecified