Provider Demographics
NPI:1952553737
Name:TIWARI, BHABISWAR (MD)
Entity Type:Individual
Prefix:
First Name:BHABISWAR
Middle Name:
Last Name:TIWARI
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 1:40 W HAMILTON AVE
Mailing Address - Street 2:APT # 1A
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2371
Mailing Address - Country:US
Mailing Address - Phone:201-894-0295
Mailing Address - Fax:
Practice Address - Street 1:3912 HIGHLANDS BLVD
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-1902
Practice Address - Country:US
Practice Address - Phone:551-497-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program