Basic Information
| Provider Information | |||||||||
| NPI: | 1194705715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAJWA | ||||||||
| FirstName: | ZARAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1851 WEST END AVE | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179012050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706247337 | ||||||||
| FaxNumber: | 5706241782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1851 WEST END AVE | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179012050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706247337 | ||||||||
| FaxNumber: | 5706241782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD064871L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001701931 | 05 | PA | MEDICAID |