Provider Demographics
NPI:1497898894
Name:BHAWAN, PRATIBHA (MD)
Entity Type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:
Last Name:BHAWAN
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 1:1 AVERY ST
Mailing Address - Street 2:UNIT-31 A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1022
Mailing Address - Country:US
Mailing Address - Phone:617-884-5660
Mailing Address - Fax:
Practice Address - Street 1:QUIGLEY MEM HOSP, SOLDIERS HOME
Practice Address - Street 2:91 CREST AVENUE
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-884-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39967208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice