Healthcare Provider Details

I. General information

NPI: 1255346789
Provider Name (Legal Business Name): ANITA BHARDWAJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ROYALTON RD STE 100
BROADVIEW HTS OH
44147-2592
US

IV. Provider business mailing address

PO BOX 74610
CLEVELAND OH
44194-0693
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-1487
  • Fax: 440-526-1487
Mailing address:
  • Phone: 440-526-6630
  • Fax: 440-526-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-090767
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-108185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: