Provider Demographics
NPI:1124351747
Name:BHATTACHARJEE, PRADIP (MD)
Entity type:Individual
Prefix:DR
First Name:PRADIP
Middle Name:
Last Name:BHATTACHARJEE
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 1:7 JEWEL CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2059
Mailing Address - Country:US
Mailing Address - Phone:732-856-4022
Mailing Address - Fax:732-856-4022
Practice Address - Street 1:65 RANCHO MIRAGE CT
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2555
Practice Address - Country:US
Practice Address - Phone:330-219-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085118207ZD0900X, 207ZP0101X
OH35.092241207ZD0900X, 207ZP0101X
NJ25MA08646700207ZP0101X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology