Provider Demographics
NPI:1376703777
Name:PINISETTY, BHARANI (MD)
Entity Type:Individual
Prefix:
First Name:BHARANI
Middle Name:
Last Name:PINISETTY
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 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 720
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4759
Mailing Address - Country:US
Mailing Address - Phone:904-387-5027
Mailing Address - Fax:904-387-2208
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 720
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4759
Practice Address - Country:US
Practice Address - Phone:904-387-5027
Practice Address - Fax:904-387-2208
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51632207R00000X
FLME113338207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01110328OtherRAILROAD MEDICARE - FL
WI51632OtherWI STATE LICENSE NUMBER
FLP01110328OtherRAILROAD MEDICARE - FL