Provider Demographics
NPI:1164927760
Name:BHATTACHARYA, PRATEEK (MD)
Entity Type:Individual
Prefix:
First Name:PRATEEK
Middle Name:
Last Name:BHATTACHARYA
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 1:65 VILLAGGE SQ DRIVE
Mailing Address - Street 2:STE 101
Mailing Address - City:S KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3039
Mailing Address - Country:US
Mailing Address - Phone:401-789-5924
Mailing Address - Fax:401-782-1770
Practice Address - Street 1:65 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2292
Practice Address - Country:US
Practice Address - Phone:401-789-5924
Practice Address - Fax:401-782-1770
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD17598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics