Provider Demographics
NPI:1669631677
Name:BHASIN, RUPA (MD)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:BHASIN
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 1:6245 NORTH FEDERAL HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1905
Mailing Address - Country:US
Mailing Address - Phone:888-886-5238
Mailing Address - Fax:
Practice Address - Street 1:100 GILLS CROSSING RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-3295
Practice Address - Country:US
Practice Address - Phone:888-886-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD401042085R0202X
CODR.00578482085R0202X
DEC1-00119152085R0202X
FLME1312972085R0202X
IN01074690A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology