Provider Demographics
NPI:1801324736
Name:BHAKTA, MEERA
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 NE CORNELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5434
Mailing Address - Country:US
Mailing Address - Phone:503-597-3130
Mailing Address - Fax:503-346-3901
Practice Address - Street 1:6355 NE CORNELL RD STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5434
Practice Address - Country:US
Practice Address - Phone:503-597-3130
Practice Address - Fax:503-346-3901
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORDO206197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program