Basic Information
| Provider Information | |||||||||
| NPI: | 1790746352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHAT | ||||||||
| FirstName: | BHAVNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAUL | ||||||||
| OtherFirstName: | BHAVNA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2007-00202 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.