Provider Demographics
NPI:1922021708
Name:GUJAR, BANSARI SACHIN (MD)
Entity Type:Individual
Prefix:
First Name:BANSARI
Middle Name:SACHIN
Last Name:GUJAR
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 1:1220B E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5813
Mailing Address - Country:US
Mailing Address - Phone:410-494-1888
Mailing Address - Fax:410-494-1008
Practice Address - Street 1:1220B E JOPPA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5813
Practice Address - Country:US
Practice Address - Phone:410-494-1888
Practice Address - Fax:410-494-1008
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080045207R00000X
MDD68523207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335733300Medicaid
MDS062-0521OtherCAREFIRST BC/BS
MD302471YFABMedicare PIN