Provider Demographics
NPI:1275539702
Name:BHALLA, NARINDER P (MD)
Entity Type:Individual
Prefix:
First Name:NARINDER
Middle Name:P
Last Name:BHALLA
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 1:185 MITYLENE PARK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7302
Mailing Address - Country:US
Mailing Address - Phone:334-387-0948
Mailing Address - Fax:334-387-0956
Practice Address - Street 1:185 MITYLENE PARK LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7302
Practice Address - Country:US
Practice Address - Phone:334-387-0948
Practice Address - Fax:334-387-0956
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221234174400000X
AL28644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005832667Medicaid
VA005832667Medicaid
VA110007553Medicare ID - Type Unspecified
AL510I060045Medicare PIN
VAG32217Medicare UPIN