Provider Demographics
NPI:1609821016
Name:BHOOLA, SNEHAL MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:SNEHAL
Middle Name:MOHAN
Last Name:BHOOLA
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 1:513 W CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 N GILBERT RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2394
Practice Address - Country:US
Practice Address - Phone:480-530-4220
Practice Address - Fax:833-465-1456
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40789207VX0201X
GA055098207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ348330Medicaid
SCG55098Medicaid
AZ348330Medicaid
AZ123579Medicare PIN
AZ348330Medicaid
GA660961832AMedicaid
SCH425507416Medicare PIN
H42550Medicare UPIN
GAP00267353Medicare PIN