Provider Demographics
NPI:1598775777
Name:SATYAM, BHAGYALAKSHMI D (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAGYALAKSHMI
Middle Name:D
Last Name:SATYAM
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 1:150 MUNDY ST
Mailing Address - Street 2:MAC IV BUILDING
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6830
Mailing Address - Country:US
Mailing Address - Phone:570-924-0930
Mailing Address - Fax:570-824-7755
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:MAC IV BUILDING
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-924-0930
Practice Address - Fax:570-824-7755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030677E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA78013450OtherGEISINGER
PA0012306130009Medicaid
PA823817OtherFPH
PA459794OtherBLUE CROSS
PA459794OtherBLUE SHIELD
PA823817OtherFPH
PA0012306130009Medicaid