Provider Demographics
NPI:1174913347
Name:ASHOK J BHARUCHA MD PC
Entity type:Organization
Organization Name:ASHOK J BHARUCHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHARUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-797-8287
Mailing Address - Street 1:603 KREAMER AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6858
Mailing Address - Country:US
Mailing Address - Phone:608-797-8287
Mailing Address - Fax:814-690-2151
Practice Address - Street 1:119 S BURROWES ST
Practice Address - Street 2:SUIE 602
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3894
Practice Address - Country:US
Practice Address - Phone:608-797-8287
Practice Address - Fax:814-690-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070573L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL813550001OtherMEDICARE PTAN
F98169Medicare UPIN