Basic Information
Provider Information
NPI: 1548653199
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHANJI
FirstName: YASIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 N WOLFE ST
Address2: TOWER 110
City: BALTIMORE
State: MD
PostalCode: 212870005
CountryCode: US
TelephoneNumber: 4109555000
FaxNumber:  
Practice Location
Address1: 600 N WOLFE ST
Address2: TOWER 110
City: BALTIMORE
State: MD
PostalCode: 212870005
CountryCode: US
TelephoneNumber: 4109555000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/06/2015
LastUpdateDate: 03/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X6897MDY Allopathic & Osteopathic PhysiciansSurgery 
390200000X6897MDN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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