Provider Demographics
NPI:1013022557
Name:BHATT, SHIV S (MD)
Entity Type:Individual
Prefix:MR
First Name:SHIV
Middle Name:S
Last Name:BHATT
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:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13479
Mailing Address - Country:US
Mailing Address - Phone:315-336-7499
Mailing Address - Fax:315-336-3831
Practice Address - Street 1:1617 NORTH JAMES STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13479
Practice Address - Country:US
Practice Address - Phone:315-336-7499
Practice Address - Fax:315-336-3831
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146859207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418560Medicaid
NY711953OtherMVP
NY54292BMedicare ID - Type Unspecified
NY711953OtherMVP