Provider Demographics
NPI:1922268176
Name:BHUMKAR, NISHITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHITA
Middle Name:
Last Name:BHUMKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NISHITA
Other - Middle Name:
Other - Last Name:BHUMKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 73488
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0488
Mailing Address - Country:US
Mailing Address - Phone:855-722-9700
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:2219 RIMLAND DR STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8759
Practice Address - Country:US
Practice Address - Phone:855-722-9700
Practice Address - Fax:425-391-5701
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR125988207R00000X
WAMD60940610207R00000X
WA60940610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922268176Medicaid
ORP01547772OtherRR ,MEDICARE - PH&S
OR500612766Medicaid