Provider Demographics
NPI:1154392611
Name:BATRA, BOBBY (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:BATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HUNTS BLUFF
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152
Mailing Address - Country:US
Mailing Address - Phone:443-708-8882
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:443-442-2300
Practice Address - Fax:443-442-2338
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078214208000000X
MDD0068828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4670365-10Medicaid
MIN63770004Medicare ID - Type Unspecified
MI4670365-10Medicaid