Provider Demographics
NPI:1306071519
Name:BHATIA, RUCHI
Entity type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MAIN ST
Mailing Address - Street 2:APT#208
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1236
Mailing Address - Country:US
Mailing Address - Phone:917-587-7976
Mailing Address - Fax:
Practice Address - Street 1:101 PHOENIX AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4471
Practice Address - Country:US
Practice Address - Phone:860-799-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0102071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008032197Medicaid