Provider Demographics
NPI:1528117181
Name:BHASKARARA NALAM MD A MED CORP
Entity type:Organization
Organization Name:BHASKARARA NALAM MD A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHASKARARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:NALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-365-6381
Mailing Address - Street 1:58471 29 PALMS HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-365-6381
Mailing Address - Fax:760-365-5834
Practice Address - Street 1:58471 29 PALMS HWY
Practice Address - Street 2:STE 202
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-365-6381
Practice Address - Fax:760-365-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA352632086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A352630Medicaid
C03939Medicare UPIN
CA00A352630Medicaid