Provider Demographics
NPI:1720062391
Name:BHATT, BHAVESH (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAVESH
Middle Name:
Last Name:BHATT
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 1:607 TIMBERDALE LN
Mailing Address - Street 2:STE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3043
Mailing Address - Country:US
Mailing Address - Phone:281-440-3005
Mailing Address - Fax:281-444-9070
Practice Address - Street 1:3643 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-470-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1978207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045907501Medicaid
TX110170113OtherRR MEDICARE PIN
TX110170113OtherRR MEDICARE PIN
G69753Medicare UPIN