Provider Demographics
NPI:1851344410
Name:BATHIJA, PUSHPA J (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
Middle Name:J
Last Name:BATHIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4565 DRESSLER ROAD NW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2579
Mailing Address - Country:US
Mailing Address - Phone:330-493-0013
Mailing Address - Fax:330-493-6973
Practice Address - Street 1:4565 DRESSLER ROAD NW
Practice Address - Street 2:SUITE 111
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2579
Practice Address - Country:US
Practice Address - Phone:330-493-0013
Practice Address - Fax:330-493-6973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35037453B207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330976Medicaid
OHBA04323462Medicare ID - Type Unspecified
A75624Medicare UPIN