Provider Demographics
NPI:1205813151
Name:BHATIA, BHAWNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:BHAWNA
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 S MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9596
Mailing Address - Country:US
Mailing Address - Phone:419-868-1696
Mailing Address - Fax:419-868-5223
Practice Address - Street 1:1106 S MCCORD RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9596
Practice Address - Country:US
Practice Address - Phone:419-868-1696
Practice Address - Fax:419-868-5223
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352194Medicaid