Healthcare Provider Details

I. General information

NPI: 1174724306
Provider Name (Legal Business Name): AJAY BHATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 PERIMETER DR STE B
DUBLIN OH
43016-2521
US

IV. Provider business mailing address

6880 PERIMETER DR STE B
DUBLIN OH
43016-2521
US

V. Phone/Fax

Practice location:
  • Phone: 380-204-5125
  • Fax: 380-204-6491
Mailing address:
  • Phone: 380-204-5125
  • Fax: 380-204-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number57.012544
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-094880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: