Provider Demographics
NPI:1801041983
Name:VIPULKUMAR BHALODIYA, MD PC
Entity Type:Organization
Organization Name:VIPULKUMAR BHALODIYA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIPULKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALODIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-324-8900
Mailing Address - Street 1:555 NEWFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3330
Mailing Address - Country:US
Mailing Address - Phone:203-324-8900
Mailing Address - Fax:
Practice Address - Street 1:555 NEWFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3330
Practice Address - Country:US
Practice Address - Phone:203-324-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG90123Medicare UPIN