MEDICARE: DR. PREMILA BHAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	230740	NY
2	207RN0300X	Nephrology Physician	230740	NY

General Provider Information

NPI Number	:	1083818546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREMILA BHAT M.D.

Provider Business Mailing Address
First Line	:	2314 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2526
Country	:	US
Telephone Number	:	347-312-3041
Fax Number	:	718-899-0175

Provider Business Practice Location Address
First Line	:	2314 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2526
Country	:	US
Telephone Number	:	347-312-3041
Fax Number	:	718-762-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	10/30/2015

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