Basic Information
| Provider Information | |||||||||
| NPI: | 1720601404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHUVA | ||||||||
| FirstName: | RONAK | ||||||||
| MiddleName: | DHIRAJ | ||||||||
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| Credential: | M.B.B.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 MAIN STREET, UNIVERSITY AT BUFFALO, JACOBS SCHOOL O | ||||||||
| Address2: | SUITE NUMBER/ROOM 7230 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168296132 | ||||||||
| FaxNumber: | 7168293999 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 MAIN STREET, UNIVERSITY AT BUFFALO, JACOBS SCHOOL O | ||||||||
| Address2: | SUITE NUMBER/ROOM 7230 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168296132 | ||||||||
| FaxNumber: | 7168293999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2020 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.