Provider Demographics
NPI:1770545584
Name:BHAT, RAJA G (MD)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:G
Last Name:BHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5106 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7054
Mailing Address - Country:US
Mailing Address - Phone:910-395-6400
Mailing Address - Fax:910-395-5953
Practice Address - Street 1:5106 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7054
Practice Address - Country:US
Practice Address - Phone:910-395-6400
Practice Address - Fax:910-395-5953
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7915417Medicaid
C49797Medicare UPIN
203012Medicare ID - Type Unspecified