Provider Demographics
NPI:1982691390
Name:BHATNAGAR, PRABHA (MD)
Entity Type:Individual
Prefix:
First Name:PRABHA
Middle Name:
Last Name:BHATNAGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2832
Mailing Address - Country:US
Mailing Address - Phone:510-865-1244
Mailing Address - Fax:510-865-1450
Practice Address - Street 1:2151 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2832
Practice Address - Country:US
Practice Address - Phone:510-865-1244
Practice Address - Fax:510-865-1450
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A3500305Medicaid
A27656Medicare UPIN
CA00A350030Medicare ID - Type Unspecified