Healthcare Provider Details

I. General information

NPI: 1356373633
Provider Name (Legal Business Name): SUDHIR BANSAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLLGATE ROAD SUITE 309/310
WARWICK RI
02886-4456
US

IV. Provider business mailing address

215 TOLLGATE ROAD SUITE 309/310
WARWICK RI
02886-4456
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-6828
  • Fax: 401-223-3040
Mailing address:
  • Phone: 401-732-6828
  • Fax: 401-223-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number7603
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: