Provider Demographics
NPI:1114171840
Name:BHATTACHARJEE, SUGATA (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUGATA
Middle Name:
Last Name:BHATTACHARJEE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4190
Mailing Address - Country:US
Mailing Address - Phone:703-380-2867
Mailing Address - Fax:
Practice Address - Street 1:61 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4190
Practice Address - Country:US
Practice Address - Phone:703-380-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA555237600000X
MASP891AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP891AUOtherSTATE LICENSE
NHA559OtherSTATE LICENSE