Provider Demographics
NPI: | 1952325441 |
---|---|
Name: | BHATT, JAY R (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JAY |
Middle Name: | R |
Last Name: | BHATT |
Suffix: | |
Gender: | M |
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: | 250 N SHADELAND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46219-4959 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11725 N ILLINOIS ST |
Practice Address - Street 2: | |
Practice Address - City: | CARMEL |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46032-3008 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-274-8800 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-27 |
Last Update Date: | 2021-01-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01059397A | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | P00740493 | Other | RAILROAD MEDICARE PTAN |
IN | P00984898 | Other | RAILROAD MEDICARE PTAN |
IN | 200512920 | Medicaid | |
IN | 000000369562 | Other | ANTHEM |
IN | P00740493 | Other | RAILROAD MEDICARE PTAN |
IN | P00984898 | Other | RAILROAD MEDICARE PTAN |