MEDICARE: DR. CHANDER S BHATIA 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
1	207P00000X	Emergency Medicine Physician	97-191	NM

General Provider Information

NPI Number	:	1265489389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDER S BHATIA MD

Provider Business Mailing Address
First Line	:	3200 BLUE HILL AVE
Second Line	:
City	:	GALLUP
State	:	NM
Zip	:	87301-6933
Country	:	US
Telephone Number	:	505-726-8261
Fax Number	:	505-726-8261

Provider Business Practice Location Address
First Line	:	1016 E ROOSEVELT AVE
Second Line	:	EMERGENCY DEPARTMENT
City	:	GRANTS
State	:	NM
Zip	:	87020-2118
Country	:	US
Telephone Number	:	505-287-5260
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/07/2008

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