MEDICARE: VINOD GOPAL BHAGAT 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	207R00000X	Internal Medicine Physician	261329	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12221WP501	OTHER	NY	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1396755955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINOD GOPAL BHAGAT MD

Provider Business Mailing Address
First Line	:	2255 ADAM CLAYTON POWELL JR BLVD # 2257
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7807
Country	:	US
Telephone Number	:	212-281-5252
Fax Number	:	212-348-5194

Provider Business Practice Location Address
First Line	:	2255 ADAM CLAYTON POWELL JR BLVD # 2257
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7807
Country	:	US
Telephone Number	:	212-289-5795
Fax Number	:	212-348-5194

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/26/2022

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