Provider Demographics
NPI:1669454526
Name:GHATALIA, BIPIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:BIPIN
Middle Name:K
Last Name:GHATALIA
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 1:103 W LEE ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:817-594-9922
Mailing Address - Fax:817-594-9923
Practice Address - Street 1:103 W LEE ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-594-9922
Practice Address - Fax:817-594-9923
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092597601Medicaid
TX10029715OtherAMERIGRP
TXM954Medicare ID - Type Unspecified
B22948Medicare UPIN