Provider Demographics
NPI:1710620760
Name:BARUA, AMIT (MBBS)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:BARUA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 READE PLACE, VASSAR BROTHERS MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3990
Mailing Address - Country:US
Mailing Address - Phone:845-790-1314
Mailing Address - Fax:
Practice Address - Street 1:45 READE PLACE, VASSAR BROTHERS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3990
Practice Address - Country:US
Practice Address - Phone:845-790-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-06-11
Deactivation Date:2023-01-13
Deactivation Code:
Reactivation Date:2023-02-06
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT79773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program