Provider Demographics
NPI:1205891793
Name:BHANOT, PUNAM (MD)
Entity type:Individual
Prefix:
First Name:PUNAM
Middle Name:
Last Name:BHANOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PUNAM
Other - Middle Name:
Other - Last Name:DHIMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1605 LAKES PARKWAY
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:770-237-4500
Mailing Address - Fax:770-237-4539
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:678-442-4321
Practice Address - Fax:770-682-2242
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056521207ZC0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00064970OtherRAILROAD MEDICARE
GAP00064970OtherRAILROAD MEDICARE
GA22BDDSNMedicare PIN