Provider Demographics
NPI:1386715126
Name:BAHTA, ELIAS BELAY (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:BELAY
Last Name:BAHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1597 WASHINGTON PIKE
Mailing Address - Street 2:SUITE A-22
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2894
Mailing Address - Country:US
Mailing Address - Phone:412-489-6919
Mailing Address - Fax:412-489-6279
Practice Address - Street 1:2242 DARLINGTON RD
Practice Address - Street 2:UNIT B
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1329
Practice Address - Country:US
Practice Address - Phone:724-384-8392
Practice Address - Fax:724-384-0066
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA201097207R00000X
PAMD436242207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA146418HRKMedicare PIN