Healthcare Provider Details

I. General information

NPI: 1487657656
Provider Name (Legal Business Name): MULKI GIRIDHAR BHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8200
  • Fax:
Mailing address:
  • Phone: 516-945-3347
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD450154
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07779700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: