Provider Demographics
NPI:1104808245
Name:BHATIA, PRAMOD (MD)
Entity type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:
Last Name:BHATIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEDICAL OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2213
Mailing Address - Country:US
Mailing Address - Phone:256-761-1729
Mailing Address - Fax:
Practice Address - Street 1:204 MEDICAL OFFICE PARK
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2213
Practice Address - Country:US
Practice Address - Phone:256-761-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14893207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32998Medicare UPIN
000081629Medicare ID - Type Unspecified