Basic Information
| Provider Information | |||||||||
| NPI: | 1659654465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINI BHASKAR MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12333 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816480 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 3168 BRAVERTON ST | ||||||||
| Address2: | 330 | ||||||||
| City: | EDGEWATER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210372674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109563090 | ||||||||
| FaxNumber: | 4109563063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2011 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BHASKAR | ||||||||
| AuthorizedOfficialFirstName: | MINI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4434816464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.