Healthcare Provider Details

I. General information

NPI: 1891746012
Provider Name (Legal Business Name): KRISHNA PRASAD BHAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 CARTHAGE ST
SANFORD NC
27330-8984
US

IV. Provider business mailing address

1303 CARTHAGE ST
SANFORD NC
27330-8984
US

V. Phone/Fax

Practice location:
  • Phone: 919-292-2468
  • Fax: 919-292-2167
Mailing address:
  • Phone: 919-292-2468
  • Fax: 919-292-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2007-00814
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: