Provider Demographics
NPI:1376576967
Name:BHIWANDI, POURU P (M D)
Entity Type:Individual
Prefix:DR
First Name:POURU
Middle Name:P
Last Name:BHIWANDI
Suffix:
Gender:F
Credentials:M D
Other - Prefix:MS
Other - First Name:POURUCHIS
Other - Middle Name:P
Other - Last Name:BHIWANDIWALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3100 DURALEIGH RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:919-782-8882
Mailing Address - Fax:919-782-8028
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 307
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-782-8882
Practice Address - Fax:919-782-8028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32197207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD92686Medicare UPIN