Provider Demographics
NPI:1922269604
Name:BHASKAR, NUTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NUTAN
Middle Name:
Last Name:BHASKAR
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 1:154A W FOOTHILL BLVD # 281
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3847
Mailing Address - Country:US
Mailing Address - Phone:626-914-5219
Mailing Address - Fax:
Practice Address - Street 1:415 W CARROLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-914-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7721207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199127001Medicaid
AR686501OtherMEDICARE ID# FOR CHI ST. VINCENT LITTLE ROCK DIAGNOSTIC CLINIC
AR299485OtherMEDICARE