Provider Demographics
NPI:1760419675
Name:BANSAL, TEJ VARNA (MD)
Entity Type:Individual
Prefix:
First Name:TEJ
Middle Name:VARNA
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TOLLGATE ROAD
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:401-223-3040
Practice Address - Street 1:215 TOLLGATE ROAD
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:401-223-3040
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000202684OtherBLUE CHIP
0000020052001OtherBLUE CROSS
0000020052001OtherBLUE CROSS