Provider Demographics
NPI:1699823435
Name:BHANDARY, AMAR NATH (MD)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:NATH
Last Name:BHANDARY
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 1:7100 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7151
Mailing Address - Country:US
Mailing Address - Phone:405-841-3337
Mailing Address - Fax:405-841-3338
Practice Address - Street 1:7100 N CLASSEN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7151
Practice Address - Country:US
Practice Address - Phone:405-841-3337
Practice Address - Fax:405-841-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100821740BMedicaid
OK108594600OtherUS DEPT OF LABOR WORK COM
OK100821740BMedicaid