Provider Demographics
NPI:1528092996
Name:BHATTACHARYA, ALOK (MD)
Entity type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:BHATTACHARYA
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:PO BOX 14211
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-1511
Mailing Address - Country:US
Mailing Address - Phone:510-791-2442
Mailing Address - Fax:
Practice Address - Street 1:1900 MOWRY AVE STE 301
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-791-2442
Practice Address - Fax:510-791-2603
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A422572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422574Medicaid
CAA29541Medicare UPIN
CA00A422574Medicaid