Provider Demographics
NPI:1245611250
Name:BHANDAL, HARJOT SINGH (MD)
Entity Type:Individual
Prefix:
First Name:HARJOT
Middle Name:SINGH
Last Name:BHANDAL
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 22988
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4480
Mailing Address - Country:US
Mailing Address - Phone:844-527-7369
Mailing Address - Fax:844-847-4943
Practice Address - Street 1:416 AVIATION BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1032
Practice Address - Country:US
Practice Address - Phone:844-527-7369
Practice Address - Fax:844-847-4943
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA147426208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB8626143OtherDEA