Provider Demographics
NPI:1245217975
Name:BHULLAR, SATINDER S (MD)
Entity Type:Individual
Prefix:
First Name:SATINDER
Middle Name:S
Last Name:BHULLAR
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:PO BOX 3066
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0233
Mailing Address - Country:US
Mailing Address - Phone:740-676-4645
Mailing Address - Fax:740-671-6333
Practice Address - Street 1:3000 GUERNSEY ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-676-4623
Practice Address - Fax:304-905-9150
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034731207Q00000X
WV13693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200679Medicaid
OH0200679Medicaid
OH0525262Medicare ID - Type Unspecified
WV0525263Medicare PIN