Provider Demographics
NPI:1346246592
Name:BATHIJA, NANDKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDKUMAR
Middle Name:
Last Name:BATHIJA
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 1:81 BALL PARK RD
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1701
Mailing Address - Country:US
Mailing Address - Phone:606-573-8100
Mailing Address - Fax:606-573-8105
Practice Address - Street 1:81 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1701
Practice Address - Country:US
Practice Address - Phone:606-573-8100
Practice Address - Fax:606-573-8105
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16927207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64053002Medicaid
KY3374796Medicare PIN
KYU73349Medicare UPIN