Healthcare Provider Details

I. General information

NPI: 1801935598
Provider Name (Legal Business Name): ASHOK BHANUSHALI M.D, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD440163
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number002735
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier02830335
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier02186203
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICAID GROUP#
# 3
IdentifierW35021
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGROUP #
# 4
Identifier02186161
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICAID GROUP#
# 5
IdentifierW34991
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGROUP #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: