Basic Information
Provider Information
NPI: 1104821909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHALODIA
FirstName: USHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2005
Address2:  
City: EAST SYRACUSE
State: NY
PostalCode: 130574505
CountryCode: US
TelephoneNumber: 3154490513
FaxNumber: 3154452936
Practice Location
Address1: 150 BROAD ST
Address2:  
City: HAMILTON
State: NY
PostalCode: 133469575
CountryCode: US
TelephoneNumber: 3154707828
FaxNumber: 3154705811
Other Information
ProviderEnumerationDate: 06/17/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X167482NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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