Provider Demographics
NPI:1740290618
Name:BHATTA, KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:BHATTA
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 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1146
Mailing Address - Country:US
Mailing Address - Phone:207-474-8337
Mailing Address - Fax:207-474-8397
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1146
Practice Address - Country:US
Practice Address - Phone:207-474-8337
Practice Address - Fax:207-474-8397
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013202208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE006979OtherTRICARE
MEF35241OtherHARVARD PILGRIM
ME1042383OtherAETNA
ME015937OtherANTHEM
MEM75481OtherCIGNA
MEM75481OtherCIGNA
ME015937OtherANTHEM