Provider Demographics
NPI:1851166516
Name:BHAGAT, MAITRI
Entity Type:Individual
Prefix:
First Name:MAITRI
Middle Name:
Last Name:BHAGAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 THE GRN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716-0009
Mailing Address - Country:US
Mailing Address - Phone:302-831-2226
Mailing Address - Fax:
Practice Address - Street 1:282 THE GRN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-0009
Practice Address - Country:US
Practice Address - Phone:302-831-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029156363LF0000X
DELG-0012562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily