Provider Demographics
NPI:1366476657
Name:BHARDWAJ, GAURI K (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURI
Middle Name:K
Last Name:BHARDWAJ
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 1:699 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1743
Mailing Address - Country:US
Mailing Address - Phone:607-770-0004
Mailing Address - Fax:607-770-0851
Practice Address - Street 1:699 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1743
Practice Address - Country:US
Practice Address - Phone:607-770-0004
Practice Address - Fax:607-770-0851
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1293791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00614282Medicaid
NYB157424Medicare UPIN
NY00614282Medicaid