Provider Demographics
NPI:1093832404
Name:BHAVSAR, JIGNESH (MD)
Entity type:Individual
Prefix:DR
First Name:JIGNESH
Middle Name:
Last Name:BHAVSAR
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 1:51 NORTH 39TH STREET
Mailing Address - Street 2:4 PHI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:48105-1941
Mailing Address - Country:US
Mailing Address - Phone:215-662-9189
Mailing Address - Fax:215-243-4612
Practice Address - Street 1:51 NORTH 39TH STREET
Practice Address - Street 2:4 PHI
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:48109-0368
Practice Address - Country:US
Practice Address - Phone:215-662-9189
Practice Address - Fax:215-243-4612
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439620207R00000X, 207RC0000X
MI4301084192390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program