Provider Demographics
NPI:1952390197
Name:BHATT, SAMIR M (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:M
Last Name:BHATT
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 1:2000 WASHINGTON ST STE 668
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1628
Mailing Address - Country:US
Mailing Address - Phone:617-630-1699
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON ST STE 668
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1628
Practice Address - Country:US
Practice Address - Phone:617-630-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73880207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3077268Medicaid
MAJ10939OtherBCBS
MAJ10939OtherBCBS
MA3077268Medicaid