Provider Demographics
NPI:1083929269
Name:BAVLE, ABHISHEK AMAR (MD)
Entity type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:AMAR
Last Name:BAVLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5728
Mailing Address - Country:US
Mailing Address - Phone:502-905-0916
Mailing Address - Fax:
Practice Address - Street 1:3 ASPEN CT
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-5728
Practice Address - Country:US
Practice Address - Phone:502-905-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS61292080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX417892301Medicaid