Provider Demographics
NPI:1154899292
Name:MATTA, BHAVNA (MD)
Entity type:Individual
Prefix:
First Name:BHAVNA
Middle Name:
Last Name:MATTA
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 1:24 HOSPITAL AVENUE
Mailing Address - Street 2:HOSPITALIST OFFICE, DANBURY HOSPITAL
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-739-8105
Mailing Address - Fax:203-749-9092
Practice Address - Street 1:24 HOSPITAL AVENUE
Practice Address - Street 2:DANBURY HOSPITAL
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-460-0000
Practice Address - Fax:203-749-9092
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68899207R00000X
390200000X
CTCT-68899208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program