Provider Demographics
NPI:1629181458
Name:BHAGRATH, RAVINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:SINGH
Last Name:BHAGRATH
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 1:255 CHURCH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3476
Mailing Address - Country:US
Mailing Address - Phone:606-432-9456
Mailing Address - Fax:606-432-2140
Practice Address - Street 1:255 CHURCH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-432-9456
Practice Address - Fax:606-432-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30095174400000X
KY611422406207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64030091Medicaid
KY1818401Medicare PIN
KY64030091Medicaid