Healthcare Provider Details

I. General information

NPI: 1174913347
Provider Name (Legal Business Name): ASHOK J BHARUCHA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S BURROWES ST SUIE 602
STATE COLLEGE PA
16801-3894
US

IV. Provider business mailing address

603 KREAMER AVE
LEWISBURG PA
17837-6858
US

V. Phone/Fax

Practice location:
  • Phone: 608-797-8287
  • Fax: 814-690-2151
Mailing address:
  • Phone: 608-797-8287
  • Fax: 814-690-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD070573L
License Number StatePA

VIII. Authorized Official

Name: DR. ASHOK J BHARUCHA
Title or Position: MD
Credential:
Phone: 608-797-8287