Provider Demographics
NPI:1023289121
Name:BHASKARAN, DHARMENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:DHARMENDRA
Middle Name:
Last Name:BHASKARAN
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:PO BOX 603898
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3898
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:834 W MEETING ST
Practice Address - Street 2:SUITE F
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6251
Practice Address - Country:US
Practice Address - Phone:803-285-8777
Practice Address - Fax:803-285-8776
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine