Provider Demographics
NPI:1386616308
Name:BHAMBHVANI, DINESH G (MD)
Entity type:Individual
Prefix:
First Name:DINESH
Middle Name:G
Last Name:BHAMBHVANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PENNSYLVANIA AVE
Mailing Address - Street 2:610
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2158
Mailing Address - Country:US
Mailing Address - Phone:817-962-2340
Mailing Address - Fax:817-840-5870
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:610
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-962-2340
Practice Address - Fax:817-840-5870
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL260892084N0400X
TXN49482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
167351200OtherUS DEPT OF LABOR WC
P00148699OtherRR MEDICARE
AL009962225Medicaid
AL051523304OtherBC
AL009962225Medicaid
167351200OtherUS DEPT OF LABOR WC
I18616Medicare UPIN