MEDICARE: DR. MAURICE BACHAWATI 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	2084P0800X	Psychiatry Physician	ME147434	FL
2	2084P0800X	Psychiatry Physician	D56596	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1366425779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE BACHAWATI M.D.

Provider Business Mailing Address
First Line	:	303 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	410-938-3000
Fax Number	:	410-938-5131

Provider Business Practice Location Address
First Line	:	6501 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21204-6819
Country	:	US
Telephone Number	:	410-938-3000
Fax Number	:	410-938-5131

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	10/19/2020

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Directions to “ DR. MAURICE BACHAWATI M.D.” Practice Location

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