Provider Demographics
NPI:1740358332
Name:PAUL, MADAN BHATIA (MD)
Entity type:Individual
Prefix:
First Name:MADAN
Middle Name:BHATIA
Last Name:PAUL
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 1:825 WALTON AVE
Mailing Address - Street 2:DOCTORS OFFICE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2306
Mailing Address - Country:US
Mailing Address - Phone:718-402-1800
Mailing Address - Fax:718-402-2366
Practice Address - Street 1:825 WALTON AVE
Practice Address - Street 2:DOCTORS OFFICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2306
Practice Address - Country:US
Practice Address - Phone:718-402-1800
Practice Address - Fax:718-402-2366
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123917207R00000X, 207RG0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00232980Medicaid
346251Medicare ID - Type Unspecified
C08933Medicare UPIN