Provider Demographics
NPI:1063048643
Name:BHUSHAN, BHARAT (ARNP)
Entity type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PAXTON WAY
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3387
Mailing Address - Country:US
Mailing Address - Phone:860-593-0920
Mailing Address - Fax:
Practice Address - Street 1:241 PAXTON WAY
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3387
Practice Address - Country:US
Practice Address - Phone:860-593-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily