Provider Demographics
NPI:1518210459
Name:BULSARA, PRADIP B
Entity type:Individual
Prefix:MR
First Name:PRADIP
Middle Name:B
Last Name:BULSARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 DOWNEY PL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3950
Mailing Address - Country:US
Mailing Address - Phone:704-917-9804
Mailing Address - Fax:
Practice Address - Street 1:533 DOWNEY PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3950
Practice Address - Country:US
Practice Address - Phone:704-917-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist