Healthcare Provider Details

I. General information

NPI: 1184760555
Provider Name (Legal Business Name): NIRANJAN BHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF PEDIATRIC INFECTIOUS DISEASES 200 NORTH WOLFE STREET, ROOM 3093
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

9683 HALSTEAD AVE
LAUREL MD
20723-1873
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-3917
  • Fax:
Mailing address:
  • Phone: 301-776-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD00042492
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: