Provider Demographics
NPI:1235629239
Name:BHANDARI, SANJEEB SUDARSHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SANJEEB
Middle Name:SUDARSHAN
Last Name:BHANDARI
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 1:12500 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:667-218-8253
Mailing Address - Fax:240-964-7000
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:667-218-8253
Practice Address - Fax:240-964-7000
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0093442207P00000X
VA0116031285390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty