Healthcare Provider Details

I. General information

NPI: 1750585089
Provider Name (Legal Business Name): OMPRAKASH M BHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 54TH ST
PHILADELPHIA PA
19143-1900
US

IV. Provider business mailing address

DEPT 4931
CAROL STREAM IL
60122-4931
US

V. Phone/Fax

Practice location:
  • Phone: 866-344-0543
  • Fax: 866-344-3934
Mailing address:
  • Phone: 866-540-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number235721
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD068893L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: