Provider Demographics
NPI:1649364381
Name:BHAGAT, VISHAL KAUSHIKBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:KAUSHIKBHAI
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:202 DUKE OF GLOUCESTER ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1372
Mailing Address - Country:US
Mailing Address - Phone:540-345-4900
Mailing Address - Fax:540-345-4179
Practice Address - Street 1:202 DUKE OF GLOUCESTER ST SW
Practice Address - Street 2:C/O ALICE SERES
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1372
Practice Address - Country:US
Practice Address - Phone:540-345-4900
Practice Address - Fax:540-345-4179
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA010124890207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10131976Medicare UPIN