Provider Demographics
NPI:1902904592
Name:BHOGAL, DALJIT K (MD)
Entity Type:Individual
Prefix:DR
First Name:DALJIT
Middle Name:K
Last Name:BHOGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DALJIT
Other - Middle Name:
Other - Last Name:BADHESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1068 W BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5104
Mailing Address - Country:US
Mailing Address - Phone:610-892-0253
Mailing Address - Fax:
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-327-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422661207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH98700Medicare UPIN
PA001974723Medicaid
PAH98700Medicare UPIN