Basic Information
| Provider Information | |||||||||
| NPI: | 1720188402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOURKANTI | ||||||||
| FirstName: | BHARATHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST | ||||||||
| Address2: | STE SW200 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563564710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COOPER PLZ | ||||||||
| Address2: | COOPER ANESTHESIA ASSOCIATES | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422425 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2006 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MA63865 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 25290 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 000274907 | 01 | NJ | AMERIHEALTH PPO/PABS | OTHER | 010004097 | 01 | NJ | AMERICHOICE | OTHER | 0559165000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 1081251 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 60001309 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 2565804 | 01 | NJ | UNITED HEALTH CARE | OTHER | 7859805 | 05 | NJ | MEDICAID |