Provider Demographics
NPI:1679659411
Name:BHAT, MALATHI (MD)
Entity Type:Individual
Prefix:
First Name:MALATHI
Middle Name:
Last Name:BHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1432
Mailing Address - Country:US
Mailing Address - Phone:978-454-9703
Mailing Address - Fax:978-528-2024
Practice Address - Street 1:660 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1432
Practice Address - Country:US
Practice Address - Phone:978-454-9703
Practice Address - Fax:978-528-2024
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43809208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3118991Medicaid
MAJ14377OtherMEDICARE PTIN
MA0003039Medicare PIN