Provider Demographics
NPI:1720188402
Name:GOURKANTI, BHARATHI (MD)
Entity Type:Individual
Prefix:
First Name:BHARATHI
Middle Name:
Last Name:GOURKANTI
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 1:1 FEDERAL ST
Mailing Address - Street 2:STE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-356-4710
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER ANESTHESIA ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63865207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25290OtherUNIVERSITY HEALTH PLAN
NJ000274907OtherAMERIHEALTH PPO/PABS
NJ010004097OtherAMERICHOICE
NJ0559165000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1081251OtherHORIZON NJ HEALTH
NJ60001309OtherHORIZON NJ HEALTH
NJ2565804OtherUNITED HEALTH CARE
NJ7859805Medicaid
NJ7859805Medicaid
NJ010350 CK3Medicare PIN
G37381Medicare UPIN