Provider Demographics
NPI:1255349288
Name:BHATIA, NEAL D (MD)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:D
Last Name:BHATIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9025 BALBOA AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-571-6800
Mailing Address - Fax:858-571-6801
Practice Address - Street 1:9025 BALBOA AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-571-6800
Practice Address - Fax:858-571-6801
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI35535-20207N00000X
CAG84556207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0081Medicare PIN
WI02120-0265Medicare PIN