Healthcare Provider Details

I. General information

NPI: 1164641759
Provider Name (Legal Business Name): RAJENDRA SUNAO BHATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 FARSON ST STE 126
BELPRE OH
45714-1068
US

IV. Provider business mailing address

416 COLEGATE DR BLDG 3
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-7985
  • Fax: 740-374-7990
Mailing address:
  • Phone: 740-568-4814
  • Fax: 740-374-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200500161
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberTRN13554
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35095235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: