Provider Demographics
NPI:1083818546
Name:BHAT, PREMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:PREMILA
Middle Name:
Last Name:BHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2526
Mailing Address - Country:US
Mailing Address - Phone:347-312-3041
Mailing Address - Fax:718-899-0175
Practice Address - Street 1:2314 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2526
Practice Address - Country:US
Practice Address - Phone:347-312-3041
Practice Address - Fax:718-762-9696
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230740207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine