Basic Information
| Provider Information | |||||||||
| NPI: | 1164641759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHATI | ||||||||
| FirstName: | RAJENDRA | ||||||||
| MiddleName: | SUNAO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 COLEGATE DR BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457509549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405684814 | ||||||||
| FaxNumber: | 7403743165 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 FARSON ST STE 126 | ||||||||
| Address2: | |||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403747985 | ||||||||
| FaxNumber: | 7403747990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 200500161 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | TRN13554 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 2086X0206X | 35095235 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000714914 | 01 | OH | ANTHEM | OTHER | 3136823 | 05 | OH | MEDICAID | 000000711856 | 01 | OH | ANTHEM | OTHER | 3810019471 | 05 | WV | MEDICAID |