Healthcare Provider Details

I. General information

NPI: 1962415430
Provider Name (Legal Business Name): PRABHAT KUMAR BHAMA MD, MPH, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE STE 310
EVERETT WA
98201-1677
US

IV. Provider business mailing address

1330 ROCKEFELLER AVE STE 310
EVERETT WA
98201-1677
US

V. Phone/Fax

Practice location:
  • Phone: 425-297-5359
  • Fax:
Mailing address:
  • Phone: 425-297-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD61030796
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD61030796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: