Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 35067633B | OH |
NPI | 1003801689 |
---|---|
Provider Name | Utpal K Bhanja |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Gallipolis, OH 45631-1539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076262001 | (05) | WV |
0996605 | (05) | OH |
7100567180 | (05) | KY |
BB3584922 | DEA (01) | KY |
F63064 | (02) |