Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 2010015537 | MO |
Y | 207RN0300X | Nephrologist | MD454185 | PA |
N | 2080P0210X | Pediatric Nephrologist | 2010015537 | MO |
NPI | 1679675748 |
---|---|
Provider Name | Prasad Balkrishna Bichu |
First Address | Beaver, PA 15009-9727 |
Second Address | Beaver, PA 15009-9727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 05/08/2016 |