Provider Demographics
NPI:1558363358
Name:BHAGAT, RAJESH G (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:G
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:G
Other - Last Name:BHAGAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:292 EAST BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-424-1790
Mailing Address - Fax:570-424-1791
Practice Address - Street 1:292 EAST BROWN STREET
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-424-1790
Practice Address - Fax:570-424-1791
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-030862-E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104119OtherHIGHMARK BLUE SHIELD
PA104119OtherBLUE SHIELD
PA440783OtherFIRST PRIORITY HEALTH
PA104119OtherBLUE SHIELD
PA104119OtherHIGHMARK BLUE SHIELD