Provider Demographics
NPI:1790786846
Name:BENDRE, DHANANJAY DEODATTA (MD)
Entity Type:Individual
Prefix:DR
First Name:DHANANJAY
Middle Name:DEODATTA
Last Name:BENDRE
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 1:1775 ONE HEALING PLACE
Mailing Address - Street 2:RADIATION ONCOLOGY SPECIALISTS
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-5255
Mailing Address - Fax:850-431-6039
Practice Address - Street 1:1775 ONE HEALING PLACE
Practice Address - Street 2:RADIATION ONCOLOGY SPECIALISTS
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-431-5255
Practice Address - Fax:850-431-6039
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361044782085R0001X
FLME1188332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104478Medicaid
IL036104478Medicaid
H34323Medicare UPIN
749641009Medicare PIN
ILL85125Medicare PIN