Provider Demographics
NPI:1154381119
Name:ROY, BHOLA NATH (MD)
Entity type:Individual
Prefix:DR
First Name:BHOLA
Middle Name:NATH
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3523 CHRISMAR CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1197
Mailing Address - Country:US
Mailing Address - Phone:412-257-1836
Mailing Address - Fax:412-257-1837
Practice Address - Street 1:609 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2060
Practice Address - Country:US
Practice Address - Phone:412-257-1836
Practice Address - Fax:412-257-1837
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 420560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200907216OtherCIGNA
PA200907216OtherINTERGROUP
PA200907216OtherUMWA
PA7945570OtherAETNA NON HMO
PA200907216OtherPHCS
PA312289OtherUPMC HEALTHPLAN
PA3610955OtherAETNA HMO
PA0019157310009Medicaid
PA155024OtherMEDPLUS
PWP00144641OtherRAILROAD MEDICARE
PAP006301OtherGATEWAY HEALTH PLAN
PW1453897OtherBLUE CROSS / BLUE SHIELD
PA200907216OtherUNITED HEALTHCARE
PA204164OtherFEDERAL BLACK LUNG
PA239019OtherHEALTHAMERICA
PA239019OtherHEALTHAMERICA
PA067358S3DMedicare ID - Type Unspecified