Provider Demographics
NPI:1942366885
Name:NALAM, BHASKARARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:BHASKARARAO
Middle Name:
Last Name:NALAM
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 1:5538 SATINLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5058
Mailing Address - Country:US
Mailing Address - Phone:760-668-7828
Mailing Address - Fax:
Practice Address - Street 1:58471 29 PALNS HWY
Practice Address - Street 2:STE 202
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-365-6381
Practice Address - Fax:760-365-5834
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35263208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A352632Medicaid
CA00A352630Medicaid
C03939Medicare UPIN
CA00A352630Medicare ID - Type Unspecified