1891229449 NPI number — SRISHTI LIPSA BHAGAT M.D.-PH.D.

Table of content: SRISHTI LIPSA BHAGAT M.D.-PH.D. (NPI 1891229449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891229449 NPI number — SRISHTI LIPSA BHAGAT M.D.-PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHAGAT
Provider First Name:
SRISHTI
Provider Middle Name:
LIPSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.-PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARVEY
Provider Other First Name:
SRISHTI
Provider Other Middle Name:
LIPSA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891229449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 EASTERN AVE
Provider Second Line Business Mailing Address:
MASON F. LORD BUILDING CENTER TOWER 3RD FLOOR, ROOM 342
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224-2734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-550-3350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-832-2820
Provider Business Practice Location Address Fax Number:
336-832-2883
Provider Enumeration Date:
04/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  202101842 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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