Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 41219 | IA |
N | 111NI0900X | Internist | 41219 | IA |
N | 207R00000X | Internist | A97494 | CA |
N | 111NI0900X | Internist | A97494 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | 41219 | IA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 41219 | IA |
NPI | 1124155858 |
---|---|
Provider Name | Dr. Prashant Dattatraya Bhave |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 20/05/2019 |