Provider Demographics
NPI:1134158991
Name:BHAT, SHRIDHAR VENKATRAMEN (MD)
Entity type:Individual
Prefix:MR
First Name:SHRIDHAR
Middle Name:VENKATRAMEN
Last Name:BHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 N ROBINSON ST
Mailing Address - Street 2:STE 305
Mailing Address - City:RICH
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-780-2610
Mailing Address - Fax:804-649-1041
Practice Address - Street 1:110 N ROBINSON ST
Practice Address - Street 2:STE 305
Practice Address - City:RICH
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-780-2610
Practice Address - Fax:804-649-1041
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030754207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006059881Medicaid
VAC06277Medicare ID - Type Unspecified
B05488Medicare UPIN