Provider Demographics
NPI:1386606234
Name:BANDY, BIBHAS C (MD)
Entity type:Individual
Prefix:
First Name:BIBHAS
Middle Name:C
Last Name:BANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5747
Mailing Address - Country:US
Mailing Address - Phone:301-790-0444
Mailing Address - Fax:301-739-3275
Practice Address - Street 1:363 S CLEVELAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5747
Practice Address - Country:US
Practice Address - Phone:301-790-0444
Practice Address - Fax:301-739-3275
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015485207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD710031100Medicaid
DCE4250001OtherFEDERAL BLUE SHIELD
MD221028OtherMAMSI HEALTH PLANS
MD041923465AOtherTRAVELERS MEDICARE
MDC043OtherCAREFIRST BCBS
MD08357440005OtherCIGNA
MDC043Medicare PIN
MD08357440005OtherCIGNA