Basic Information
Provider Information
NPI: 1306007232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHAT
FirstName: DEEPTI
MiddleName: PAGARE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3200 E CAMELBACK RD STE 250
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850182327
CountryCode: US
TelephoneNumber: 6029331813
FaxNumber:  
Practice Location
Address1: 1919 E THOMAS RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 85016
CountryCode: US
TelephoneNumber: 6029333366
FaxNumber: 6029334264
Other Information
ProviderEnumerationDate: 06/23/2008
LastUpdateDate: 06/19/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X57014210OHN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0202X49280AZY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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