Provider Demographics
NPI:1952335382
Name:BAJWA, MEHTAB S (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHTAB
Middle Name:S
Last Name:BAJWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5440
Mailing Address - Fax:315-472-5010
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5440
Practice Address - Fax:315-472-5010
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236419-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAPPLIED FORMedicaid
NYAPPLIED FORMedicare UPIN
NYAPPLIED FORMedicaid
J400002303Medicare UPIN