Healthcare Provider Details

I. General information

NPI: 1770734956
Provider Name (Legal Business Name): RAVINDER S. BHAGRATH M.D. PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHURCH ST SUITE 203
PIKEVILLE KY
41501-3476
US

IV. Provider business mailing address

255 CHURCH ST SUITE 203
PIKEVILLE KY
41501-3476
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-9456
  • Fax: 606-432-2140
Mailing address:
  • Phone: 606-432-9456
  • Fax: 606-432-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: RAVINDER SINGH BHAGRATH
Title or Position: OWNER
Credential: M.D.
Phone: 606-432-9456