Provider Demographics
NPI:1841363181
Name:BAGCHI, SONALI (MD)
Entity type:Individual
Prefix:
First Name:SONALI
Middle Name:
Last Name:BAGCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BUNNING DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4162
Mailing Address - Country:US
Mailing Address - Phone:856-751-6157
Mailing Address - Fax:
Practice Address - Street 1:301 SPRING GARDEN RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2516
Practice Address - Country:US
Practice Address - Phone:609-561-1700
Practice Address - Fax:609-567-7318
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06939300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ044796C2BOtherMEDICARE BILLING NO.
NJH09342Medicare UPIN