Provider Demographics
NPI:1194150573
Name:BANGLAWALA, SARFARAZ MUBARAK (MD)
Entity type:Individual
Prefix:DR
First Name:SARFARAZ
Middle Name:MUBARAK
Last Name:BANGLAWALA
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 1:135 RUTLEDGE AVE
Mailing Address - Street 2:MSC 550
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8903
Mailing Address - Country:US
Mailing Address - Phone:843-792-7165
Mailing Address - Fax:
Practice Address - Street 1:MUSC DEPT OF OTOLARYNGOLOGY HEAD AND NECK
Practice Address - Street 2:135 RUTLEDGE AVENUE
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36261207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC36261OtherSOUTH CAROLINA STATE LICENSE