=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912095779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRUPAD BHATT, MD. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 10/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 PLAZA CT SUITE C
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-422-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 PLAZA CT SUITE C
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-422-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. BEVERLY ROSE MOSTELLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-422-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD038914E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------