Provider Demographics
NPI:1669464343
Name:SAHU, BHAGABAT C (MD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:BHAGABAT
Middle Name:C
Last Name:SAHU
Suffix:
Gender:M
Credentials:MD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2463
Mailing Address - Country:US
Mailing Address - Phone:256-233-3303
Mailing Address - Fax:256-230-2609
Practice Address - Street 1:707 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2463
Practice Address - Country:US
Practice Address - Phone:256-233-3303
Practice Address - Fax:256-230-2609
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA98906Medicare UPIN