Provider Demographics
NPI:1134480791
Name:BHATNAGAR, DIVYA SAMBANDAN (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:SAMBANDAN
Last Name:BHATNAGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:RAMALAKSHMI
Other - Last Name:SAMBANDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8 RIVERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-739-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09936400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology