Provider Demographics
NPI:1063425635
Name:GREWAL BAHL, RANU (MD)
Entity type:Individual
Prefix:
First Name:RANU
Middle Name:
Last Name:GREWAL BAHL
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 1:27204 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4339
Mailing Address - Country:US
Mailing Address - Phone:510-732-6390
Mailing Address - Fax:510-732-1357
Practice Address - Street 1:27204 CALAROGA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4339
Practice Address - Country:US
Practice Address - Phone:510-732-6390
Practice Address - Fax:510-732-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395290Medicaid
CA00A395290OtherBLUE SHIELD OF CA PIN
CA00A395290OtherBLUE SHIELD OF CA PIN
CA00A395291Medicare PIN
CAE35204Medicare UPIN