Basic Information
Provider Information
NPI: 1003801689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHANJA
FirstName: UTPAL
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 509 MEMORIAL DR STE 2
Address2:  
City: MANCHESTER
State: KY
PostalCode: 409626196
CountryCode: US
TelephoneNumber: 6065985104
FaxNumber: 6065980983
Practice Location
Address1: 515 MEMORIAL DR STE 1
Address2:  
City: MANCHESTER
State: KY
PostalCode: 409629157
CountryCode: US
TelephoneNumber: 6065984500
FaxNumber: 6065992540
Other Information
ProviderEnumerationDate: 09/20/2005
LastUpdateDate: 03/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X52055KYY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RH0003X35067633BOHN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

ID Information
IDTypeStateIssuerDescription
099660505OH MEDICAID
710056718005KY MEDICAID
007626200105WV MEDICAID
BB358492201KYDEAOTHER


Home