MEDICARE: BANARIKAMMAJE N. BHAT 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	208000000X	Pediatrics Physician	35.040927	OH

General Provider Information

NPI Number	:	1639263957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANARIKAMMAJE N. BHAT MD

Provider Business Mailing Address
First Line	:	330 N MARKET ST
Second Line	:	P.O. BOX 369
City	:	LISBON
State	:	OH
Zip	:	44432-1146
Country	:	US
Telephone Number	:	330-424-9866
Fax Number	:	330-424-7689

Provider Business Practice Location Address
First Line	:	330 N MARKET ST
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1146
Country	:	US
Telephone Number	:	330-424-9866
Fax Number	:	330-424-7689

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/12/2007

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