Provider Demographics
NPI:1821044108
Name:BRAJESH BHATLA MD PA
Entity Type:Organization
Organization Name:BRAJESH BHATLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-412-1125
Mailing Address - Street 1:PO BOX 2835
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2835
Mailing Address - Country:US
Mailing Address - Phone:956-412-1125
Mailing Address - Fax:956-440-8854
Practice Address - Street 1:4402 E SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9290
Practice Address - Country:US
Practice Address - Phone:956-412-1125
Practice Address - Fax:956-440-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031LWOtherBC/BS
TX166456701Medicaid
TX166456701Medicaid