Provider Demographics
NPI:1851322457
Name:BAXI, NILESH (MD)
Entity Type:Individual
Prefix:
First Name:NILESH
Middle Name:
Last Name:BAXI
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINTOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707
Mailing Address - Country:US
Mailing Address - Phone:570-455-6385
Mailing Address - Fax:570-579-0355
Practice Address - Street 1:359 S MOUNTAIN BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:MOUNTAINTOP
Practice Address - State:PA
Practice Address - Zip Code:18707
Practice Address - Country:US
Practice Address - Phone:570-455-6385
Practice Address - Fax:570-579-0355
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052115L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014653330005Medicaid
08115Medicare ID - Type Unspecified
PA0014653330005Medicaid