Healthcare Provider Details

I. General information

NPI: 1720287022
Provider Name (Legal Business Name): PRAFUL U. BHATT, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 E CHURCH ST
LOCK HAVEN PA
17745-2023
US

IV. Provider business mailing address

72 E CHURCH ST
LOCK HAVEN PA
17745-2023
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-4565
  • Fax: 570-748-3034
Mailing address:
  • Phone: 570-748-4565
  • Fax: 570-748-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD025716E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PRAFUL U BHATT
Title or Position: OWNER
Credential: MD
Phone: 570-748-4565