Provider Demographics
NPI:1669456448
Name:BHANDARI, AMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:BHANDARI
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 1:2020 CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0698
Mailing Address - Country:US
Mailing Address - Phone:503-399-2424
Mailing Address - Fax:503-375-7525
Practice Address - Street 1:2020 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0698
Practice Address - Country:US
Practice Address - Phone:503-399-2424
Practice Address - Fax:503-375-7525
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278194Medicaid
ORP00274866OtherRR MEDICARE PTAN NUMBER
OR1407812365OtherNBMC NPI NUMBER-GROUP
ORR0000WFBTVOtherMEDICARE GROUP PIN
OR0577260001OtherDMERC NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORMD26073OtherOREGON MEDICAL LICENSE
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORMD26073OtherOREGON MEDICAL LICENSE