MEDICARE: KRISHNA BHATTA 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	208800000X	Urology Physician	013202	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E006979	OTHER	ME	TRICARE
2	F35241	OTHER	ME	HARVARD PILGRIM
3	1042383	OTHER	ME	AETNA
4	015937	OTHER	ME	ANTHEM
5	M75481	OTHER	ME	CIGNA

General Provider Information

NPI Number	:	1740290618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNA BHATTA M.D.

Provider Business Mailing Address
First Line	:	44 MAIN ST
Second Line	:
City	:	SKOWHEGAN
State	:	ME
Zip	:	04976-1146
Country	:	US
Telephone Number	:	207-474-8337
Fax Number	:	207-474-8397

Provider Business Practice Location Address
First Line	:	44 MAIN ST
Second Line	:
City	:	SKOWHEGAN
State	:	ME
Zip	:	04976-1146
Country	:	US
Telephone Number	:	207-474-8337
Fax Number	:	207-474-8397

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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