Provider Demographics
NPI:1750574547
Name:BHATT, ARCHIT CHANDRAVADAN (MD,, MPH)
Entity type:Individual
Prefix:DR
First Name:ARCHIT
Middle Name:CHANDRAVADAN
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD,, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:5050 NE HOYT ST STE 315
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2982
Practice Address - Country:US
Practice Address - Phone:503-215-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1551192084N0400X, 2084V0102X
MT349092084N0400X
AK1058782084N0400X
WAMD602860352084N0400X
CAA1193212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648777Medicaid
ORP01189824OtherRR MEDICARE (PH&S)-PMG
ORP01189824OtherRR MEDICARE (PH&S)-PMG
OR500648777Medicaid
ORR165674Medicare PIN
ORR192464Medicare PIN