Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT215185 | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MT215185 | PA |
NPI | 1063905115 |
---|---|
Provider Name | Anand Shripad Bhagwat |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 26/06/2020 |