Basic Information
| Provider Information | |||||||||
| NPI: | 1487628954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHATT-KOSHAL | ||||||||
| FirstName: | BELA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 PARKS HALL | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457011359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405932487 | ||||||||
| FaxNumber: | 7405930626 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 W UNION ST | ||||||||
| Address2: | EXPRESSCARE | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405942456 | ||||||||
| FaxNumber: | 7405949630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | 34-007345 | OH | N | Other Service Providers | Contractor | 207Q00000X | 34007345 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2270439 | 05 | OH | MEDICAID |