Healthcare Provider Details

I. General information

NPI: 1265967343
Provider Name (Legal Business Name): BILAL SHAHID BANGASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 06/27/2023
Certification Date: 06/14/2023
Deactivation Date: 11/27/2017
Reactivation Date: 12/07/2017

III. Provider practice location address

530 S STATE ST STE 107
DOVER DE
19901-3562
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-608-5299
  • Fax: 302-608-3885
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC1-0025760
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: