Provider Demographics
NPI:1588656300
Name:BHAGAT, JAYANT (MD)
Entity Type:Individual
Prefix:
First Name:JAYANT
Middle Name:
Last Name:BHAGAT
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 1:139 HAZARD AVE
Mailing Address - Street 2:BLD # 6
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4597
Mailing Address - Country:US
Mailing Address - Phone:860-749-0221
Mailing Address - Fax:860-749-1602
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BLD # 6
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-749-0221
Practice Address - Fax:860-749-1602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0287902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1287904Medicaid
CT1287904Medicaid
CTA62465Medicare UPIN