Basic Information
Provider Information
NPI: 1376921189
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHATT
FirstName: HIMALI
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 LONGWOOD AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556000
FaxNumber:  
Practice Location
Address1: 300 LONGWOOD AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2015
LastUpdateDate: 06/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X56398AZN Allopathic & Osteopathic PhysiciansHospitalist 
208000000X279218MAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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