Provider Demographics
NPI:1568088375
Name:BHANDOL, SUPRIANA KAUR (MD)
Entity Type:Individual
Prefix:
First Name:SUPRIANA
Middle Name:KAUR
Last Name:BHANDOL
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:THE WRIGHT CENTER FOR GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:501 S. WASHINGTON AVENUE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:570-343-4800
Practice Address - Street 1:501 S. WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-343-2383
Practice Address - Fax:570-343-4800
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
PAMD481123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program