Healthcare Provider Details

I. General information

NPI: 1376576967
Provider Name (Legal Business Name): POURU P. BHIWANDI M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: POURUCHIS P. BHIWANDIWALLA M.D.

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD SUITE 307
RALEIGH NC
27612-8106
US

IV. Provider business mailing address

3100 DURALEIGH RD SUITE 307
RALEIGH NC
27612-8106
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8882
  • Fax: 919-782-8028
Mailing address:
  • Phone: 919-782-8882
  • Fax: 919-782-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number32197
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: