Provider Demographics
NPI:1144211285
Name:BHAN, ATUL K (MBBS MD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:K
Last Name:BHAN
Suffix:
Gender:M
Credentials:MBBS MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WARREN 501
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2588
Practice Address - Fax:617-726-2365
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA37653207ZI0100X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM09066OtherBCBS MA
MA067418OtherTUFTS HEALTH PLAN
MA2091496Medicaid
MAM09066OtherBCBS MA
B75947Medicare UPIN