Provider Demographics
NPI:1225028020
Name:BAHNIWAL, CHARANJIT SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARANJIT
Middle Name:SINGH
Last Name:BAHNIWAL
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 1:6225 N STATE HIGHWAY 161 STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2241
Mailing Address - Country:US
Mailing Address - Phone:214-687-0001
Mailing Address - Fax:972-518-2100
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20666207LP2900X
OH35078000207LP2900X
MI4301503103207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCA4374OtherRAILROAD MEDICARE
WV50085563OtherAETNA
WV1807993000Medicaid
OH2670953Medicaid
MIMI14045129OtherMI MEDICARE
WVBA4095601Medicare ID - Type Unspecified
OH2670953Medicaid