Healthcare Provider Details

I. General information

NPI: 1215261789
Provider Name (Legal Business Name): MEERA BHAVSAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEERA BHAVSAR THOMAS PA-C

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

218 S 20TH ST APT 3F
PHILADELPHIA PA
19103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3301
  • Fax:
Mailing address:
  • Phone: 832-282-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052765
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: