Healthcare Provider Details

I. General information

NPI: 1679545461
Provider Name (Legal Business Name): ANITA BHANDARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

100 E PENN SQ WANAMAKER BUILDING 9TH FLR
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3749
  • Fax: 215-590-3500
Mailing address:
  • Phone: 267-425-9200
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD064719L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: