MEDICARE: DR. JOAN M BATHON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	D25083	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699730143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN M BATHON M.D.

Provider Business Mailing Address
First Line	:	630 WEST 168TH STREET
Second Line	:	10-4485
City	:	NEW YORK
State	:	NY
Zip	:	10032
Country	:	US
Telephone Number	:	212-305-6213
Fax Number	:	212-304-6070

Provider Business Practice Location Address
First Line	:	630 W 168TH ST
Second Line	:	10-445
City	:	NEW YORK
State	:	NY
Zip	:	10032-3725
Country	:	US
Telephone Number	:	212-305-6213
Fax Number	:	212-304-6070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	03/15/2011

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