Provider Demographics
NPI:1356365001
Name:BHOLA, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:BHOLA
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 1:624 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7903
Mailing Address - Country:US
Mailing Address - Phone:509-481-3876
Mailing Address - Fax:509-891-7342
Practice Address - Street 1:624 LINDEN ROAD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7903
Practice Address - Country:US
Practice Address - Phone:360-778-1334
Practice Address - Fax:360-778-1334
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807261100Medicaid
WA8426686Medicaid
G07311Medicare UPIN
ID807261100Medicaid
ID1131644Medicare ID - Type Unspecified