Healthcare Provider Details

I. General information

NPI: 1396792404
Provider Name (Legal Business Name): SHASHIKANT G BHOPALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E 1ST ST
OSWEGO NY
13126-1112
US

IV. Provider business mailing address

PO BOX 340
NEW HARTFORD NY
13413-0340
US

V. Phone/Fax

Practice location:
  • Phone: 315-343-0405
  • Fax: 315-343-5162
Mailing address:
  • Phone: 315-732-9368
  • Fax: 315-732-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192912-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: