Provider Demographics
NPI:1336411990
Name:BHAT, PRAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:
Last Name:BHAT
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 1:125 COURT ST
Mailing Address - Street 2:7KN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5663
Mailing Address - Country:US
Mailing Address - Phone:917-446-4763
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:406 NORTH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7585
Practice Address - Fax:718-486-4270
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07228497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine