MEDICARE: DR. CHERYL DEWAN BANSAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D72260	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	451330815	OTHER	MD	NPI 1774790851

General Provider Information

NPI Number	:	1174790851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL DEWAN BANSAL M.D.

Provider Business Mailing Address
First Line	:	9256 BENDIX RD STE 200A
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	443-542-0505
Fax Number	:	443-542-0506

Provider Business Practice Location Address
First Line	:	9256 BENDIX RD STE 200A
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	443-542-0505
Fax Number	:	443-542-0506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	06/29/2023

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