Healthcare Provider Details

I. General information

NPI: 1811155773
Provider Name (Legal Business Name): RAGHURAM B BHAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 SE 192ND AVE STE 200
CAMAS WA
98607-7475
US

IV. Provider business mailing address

2005 SE 192ND AVE STE 200
CAMAS WA
98607-7475
US

V. Phone/Fax

Practice location:
  • Phone: 360-440-1828
  • Fax: 217-636-4073
Mailing address:
  • Phone: 360-440-1828
  • Fax: 217-636-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD60644353
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60644353
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD60644353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: