Provider Demographics
NPI:1902046493
Name:BANSAL, MOHIT (MD)
Entity Type:Individual
Prefix:
First Name:MOHIT
Middle Name:
Last Name:BANSAL
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 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-953-8090
Mailing Address - Fax:727-953-8088
Practice Address - Street 1:1988 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3550
Practice Address - Country:US
Practice Address - Phone:727-953-8090
Practice Address - Fax:727-953-8088
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0018207X00000X
NY246504207X00000X
FLME110211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9858391OtherCIGNA HEALTHCARE
P00960351OtherRAILROAD MEDICARE
FL003703900Medicaid
FL14E5AOtherBCBS OF FLORIDA
FL1085391OtherCAREPLUS
FL003703900Medicaid