Provider Demographics
NPI:1235544198
Name:BUCKTOWARSING, BHAVNISH (MD)
Entity Type:Individual
Prefix:MR
First Name:BHAVNISH
Middle Name:
Last Name:BUCKTOWARSING
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 1:4650 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-649-9400
Mailing Address - Fax:330-649-8059
Practice Address - Street 1:4650 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-649-9400
Practice Address - Fax:330-649-8059
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35131753207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program