Provider Demographics
NPI:1689855561
Name:BAJRACHARYA, ADARSHA S (MD)
Entity type:Individual
Prefix:DR
First Name:ADARSHA
Middle Name:S
Last Name:BAJRACHARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9032 KALANI ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2674
Mailing Address - Country:US
Mailing Address - Phone:617-901-6322
Mailing Address - Fax:
Practice Address - Street 1:555 E HARDY ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4011
Practice Address - Country:US
Practice Address - Phone:310-673-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243293207R00000X, 2083C0008X
CAC186903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086337AMedicaid
MA110086337AMedicaid