Provider Demographics
NPI:1528273760
Name:BHATIA, AVNISH (MD)
Entity type:Individual
Prefix:
First Name:AVNISH
Middle Name:
Last Name:BHATIA
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 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1321
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-923-5676
Mailing Address - Fax:
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1321
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-923-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433959207RH0003X
NY235182207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102279470Medicaid
NJ0196657Medicaid
PA0061424000OtherKEYSTONE/PC
PA102279470Medicaid