Provider Demographics
NPI:1255346789
Name:BHARDWAJ, ANITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:BHARDWAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74610
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0693
Mailing Address - Country:US
Mailing Address - Phone:440-526-6630
Mailing Address - Fax:440-526-1487
Practice Address - Street 1:500 E ROYALTON RD STE 100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2592
Practice Address - Country:US
Practice Address - Phone:440-526-1487
Practice Address - Fax:440-526-1487
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090767208000000X
IL036-108185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87625Medicare UPIN