Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | MD471706 | PA |
NPI | 1437681541 |
---|---|
Provider Name | Bhavna Bali |
First Address | Hershey, PA 17033-2360 |
Second Address | Athens, GA 30606-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 25/10/2021 |