Provider Demographics
NPI:1932171071
Name:BHARUCHA, ASHOK J (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:J
Last Name:BHARUCHA
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 1:143 EDGEWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9001
Mailing Address - Country:US
Mailing Address - Phone:570-989-1921
Mailing Address - Fax:814-690-2151
Practice Address - Street 1:143 EDGEWOOD DR W
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9001
Practice Address - Country:US
Practice Address - Phone:570-989-1921
Practice Address - Fax:814-690-2151
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070573L2084P0805X, 2084P0800X, 2084P0800X, 2084P0805X
IA382662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL813550001OtherMEDICARE PTAN
IAI7123003Medicare PIN
IL813550001OtherMEDICARE PTAN