Provider Demographics
NPI:1891746012
Name:BHAT, KRISHNA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRASAD
Last Name:BHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1303 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8984
Mailing Address - Country:US
Mailing Address - Phone:919-292-2468
Mailing Address - Fax:919-292-2167
Practice Address - Street 1:1303 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-8984
Practice Address - Country:US
Practice Address - Phone:919-292-2468
Practice Address - Fax:919-292-2167
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2007-00814208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59-06923Medicaid
NC2069348AMedicare PIN