Provider Demographics
NPI:1790746352
Name:BHAT, BHAVNA (MD)
Entity Type:Individual
Prefix:
First Name:BHAVNA
Middle Name:
Last Name:BHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BHAVNA
Other - Middle Name:
Other - Last Name:KAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8036
Mailing Address - Country:US
Mailing Address - Phone:919-781-7500
Mailing Address - Fax:919-645-3440
Practice Address - Street 1:3100 BLUE RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8036
Practice Address - Country:US
Practice Address - Phone:919-781-7500
Practice Address - Fax:919-645-3440
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2075509AMedicare UPIN