Provider Demographics
NPI:1417230855
Name:BANSAL, PUNEET VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:VICTOR
Last Name:BANSAL
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 1:121 MEDICAL CENTER DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2672
Mailing Address - Country:US
Mailing Address - Phone:207-406-7310
Mailing Address - Fax:
Practice Address - Street 1:121 MEDICAL CENTER DR STE 3100
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2672
Practice Address - Country:US
Practice Address - Phone:207-406-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT60787207RC0000X
MEMD25659207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease