Provider Demographics
NPI:1619137791
Name:SUDHIR BANSAL, MD INC.
Entity Type:Organization
Organization Name:SUDHIR BANSAL, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORENCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-732-6828
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 309 / 310
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-732-6828
Mailing Address - Fax:
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 309 / 310
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-732-6828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty