Provider Demographics
NPI:1316203557
Name:BHAMBHWANI, ANMOL R (MD)
Entity Type:Individual
Prefix:
First Name:ANMOL
Middle Name:R
Last Name:BHAMBHWANI
Suffix:
Gender:F
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 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1665 VALLEY CENTER PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2346
Practice Address - Country:US
Practice Address - Phone:610-317-0208
Practice Address - Fax:610-317-0210
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458332207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program