MEDICARE: AMBAREEN A. BHARMAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C10008017	DE
2	207Q00000X	Family Medicine Physician	247240-1	NY
3	207Q00000X	Family Medicine Physician	35-123631	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114018454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBAREEN A. BHARMAL M.D.

Provider Business Mailing Address
First Line	:	5350 N MEADOWS DR
Second Line	:	SUITE 160
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2546
Country	:	US
Telephone Number	:	614-875-3592
Fax Number	:	614-875-8258

Provider Business Practice Location Address
First Line	:	5350 N MEADOWS DR
Second Line	:	SUITE 160
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2546
Country	:	US
Telephone Number	:	614-875-3592
Fax Number	:	614-875-8258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	01/26/2015

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