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NPI Code Detail

MEDICARE: ANJAN BHATTACHARYYA MD

MEDICARE: ANJAN BHATTACHARYYA MD
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
1207R00000XInternal Medicine Physician34489IA
22084P0800XPsychiatry Physician34489IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
248914OTHERIAWELLMARK BCBS

General Provider Information

NPI Number : 1134193162
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANJAN BHATTACHARYYA MD
Provider Business Mailing Address
First Line : 1438 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1027
Country : US
Telephone Number : 314-977-4828
Fax Number : 314-977-4877
Provider Business Practice Location Address
First Line : 1438 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1027
Country : US
Telephone Number : 314-977-4850
Fax Number : 314-977-4876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 05/16/2019

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