Basic Information
| Provider Information | |||||||||
| NPI: | 1487187498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALAR | ||||||||
| FirstName: | BHARVI | ||||||||
| MiddleName: | ASHOK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | DERBY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064181328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037321256 | ||||||||
| FaxNumber: | 2037321539 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 LEAVENWORTH RD | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064841881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039261206 | ||||||||
| FaxNumber: | 2039260413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 67005 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.