Basic Information
| Provider Information | |||||||||
| NPI: | 1972824357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHANSALY | ||||||||
| FirstName: | ISHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT STE 212 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976174 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 GROVE RD FL 5 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644554411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2010 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 32920 | SC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 32920 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.