Provider Demographics
NPI:1356373633
Name:BANSAL, SUDHIR (MD)
Entity type:Individual
Prefix:
First Name:SUDHIR
Middle Name:
Last Name:BANSAL
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 1:215 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 309/310
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4456
Mailing Address - Country:US
Mailing Address - Phone:401-732-6828
Mailing Address - Fax:401-223-3040
Practice Address - Street 1:215 TOLLGATE ROAD
Practice Address - Street 2:SUITE 309/310
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4456
Practice Address - Country:US
Practice Address - Phone:401-732-6828
Practice Address - Fax:401-223-3040
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7603207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
119020098OtherMEDICARE PIN
CPG002461001OtherBLUE CHIP
050461074OtherUHC
0000020098001OtherBC
E30019Medicare UPIN
119020098Medicare ID - Type Unspecified