Basic Information
| Provider Information | |||||||||
| NPI: | 1154364818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHULLAR | ||||||||
| FirstName: | NAVNEET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 SPRUCE ST | ||||||||
| Address2: | PINE 1 WEST | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191076130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158297817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 SPRUCE ST | ||||||||
| Address2: | PINE 1 WEST | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191076130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158297817 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20505 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | MD440966 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD440966 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1026514250009 | 05 | PA | MEDICAID |