Provider Demographics
NPI:1689025504
Name:BHANDUTIA, SAMIR (DO)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:BHANDUTIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 ST LUKES BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5670
Mailing Address - Country:US
Mailing Address - Phone:484-526-7246
Mailing Address - Fax:833-219-0473
Practice Address - Street 1:1700 ST. LUKE'S BOULVARD, SUITE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:484-526-7246
Practice Address - Fax:833-219-0473
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB10735400207P00000X
PAOS020669208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty