Basic Information
| Provider Information | |||||||||
| NPI: | 1740289461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKHRU | ||||||||
| FirstName: | USHA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 TROY SCHENECTADY RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182624942 | ||||||||
| FaxNumber: | 5182625291 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 TROY SCHENECTADY RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182624942 | ||||||||
| FaxNumber: | 5182625291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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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 | 207V00000X | 142214 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00567973 | 05 | NY | MEDICAID |