Basic Information
Provider Information
NPI: 1003155847
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHATTACHARYA
FirstName: SAMIRAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 12631 EAST 17TH AVENUE
Address2: MAIL STOP F493 AO1, RM 2510
City: AURORA
State: CO
PostalCode: 80045
CountryCode: US
TelephoneNumber: 3037247408
FaxNumber:  
Practice Location
Address1: THE JOHNS HOPKINS HOSPITAL
Address2: 600 NORTH WOLFE STREET
City: BALTIMORE
State: MD
PostalCode: 212872109
CountryCode: US
TelephoneNumber: 4109555000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/13/2013
LastUpdateDate: 04/03/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000XDR.0058618COY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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