Provider Demographics
NPI:1962493981
Name:BHATIA, GITASHREE (MD)
Entity Type:Individual
Prefix:
First Name:GITASHREE
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3000
Mailing Address - Fax:486-452-3069
Practice Address - Street 1:916 HWY 542
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4198
Practice Address - Country:US
Practice Address - Phone:863-419-3330
Practice Address - Fax:863-419-3258
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069162300Medicaid
FL53726OtherBCBS OF FLORIDA
FLF69878Medicare Oscar/Certification
FL53726AMedicare PIN
FL069162300Medicaid
FL53726DMedicare PIN
F69878Medicare UPIN
FL53726OtherBCBS OF FLORIDA
FL53726BMedicare PIN