MEDICARE: MOODAKARE ASHWINI 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	207L00000X	Anesthesiology Physician	D0101875	MD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467837799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOODAKARE ASHWINI BHAT M.D

Provider Business Mailing Address
First Line	:	1130 PELHAM PKWY S
Second Line	:	APT 4H
City	:	BRONX
State	:	NY
Zip	:	10461-1019
Country	:	US
Telephone Number	:	917-383-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 PELHAM PKWY S
Second Line	:	APT 4H
City	:	BRONX
State	:	NY
Zip	:	10461-1019
Country	:	US
Telephone Number	:	917-383-7997
Fax Number	:

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

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	03/03/2025

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