Provider Demographics
NPI:1487628954
Name:BHATT-KOSHAL, BELA H (DO)
Entity Type:Individual
Prefix:
First Name:BELA
Middle Name:H
Last Name:BHATT-KOSHAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PARKS HALL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1359
Mailing Address - Country:US
Mailing Address - Phone:740-593-2487
Mailing Address - Fax:740-593-0626
Practice Address - Street 1:265 W UNION ST
Practice Address - Street 2:EXPRESSCARE
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2313
Practice Address - Country:US
Practice Address - Phone:740-594-2456
Practice Address - Fax:740-594-9630
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007345171W00000X
OH34007345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270439Medicaid
OH2270439Medicaid
4060799Medicare PIN