Provider Demographics
NPI:1104823137
Name:BHATLA, SUMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:
Last Name:BHATLA
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 1:100 E CAMPUS VIEW BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4647
Mailing Address - Country:US
Mailing Address - Phone:614-396-4750
Mailing Address - Fax:614-396-4742
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 5360
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-340-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4205742085R0202X
OH35.0879502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4191111Medicare PIN
OHP00333847Medicare PIN
H80488Medicare UPIN