Provider Demographics
NPI:1851327845
Name:BANDU, BHANUMATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHANUMATHI
Middle Name:
Last Name:BANDU
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:STATE OF NJ DEPT. OF TREASURY
Mailing Address - Street 2:PO BOX 15280
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07192-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SULLIVAN WAY
Practice Address - Street 2:TRENTON PSYCHIATRIC HOSPITAL
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-633-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06642700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
008837B1FOtherMEDICARE BILLING NUMBER
008837B1FOtherMEDICARE BILLING NUMBER