Healthcare Provider Details

I. General information

NPI: 1659486199
Provider Name (Legal Business Name): ASHOK V BHALODI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N SHERMAN CT
HAZLETON PA
18201-5863
US

IV. Provider business mailing address

140 N SHERMAN CT
HAZLETON PA
18201-5863
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-7020
  • Fax: 570-501-7028
Mailing address:
  • Phone: 570-501-7020
  • Fax: 570-501-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14899
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD036656E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0129818000
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: