Provider Demographics
NPI:1639263957
Name:BHAT, BANARIKAMMAJE N (MD)
Entity Type:Individual
Prefix:
First Name:BANARIKAMMAJE
Middle Name:N
Last Name:BHAT
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 1:330 N MARKET ST
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1146
Mailing Address - Country:US
Mailing Address - Phone:330-424-9866
Mailing Address - Fax:330-424-7689
Practice Address - Street 1:330 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1146
Practice Address - Country:US
Practice Address - Phone:330-424-9866
Practice Address - Fax:330-424-7689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.040927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics