Provider Demographics
NPI:1366827362
Name:SUMIT BHUTANI, MD LLC
Entity Type:Organization
Organization Name:SUMIT BHUTANI, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-520-6496
Mailing Address - Street 1:826 WASHINGTON RD
Mailing Address - Street 2:SUITE 204 A
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5750
Mailing Address - Country:US
Mailing Address - Phone:410-525-5144
Mailing Address - Fax:410-970-4648
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:SUITE 204 A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:410-525-5144
Practice Address - Fax:410-970-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72536261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty