Provider Demographics
NPI:1174714299
Name:TRIVEDI, BHAVIKA (MD)
Entity type:Individual
Prefix:
First Name:BHAVIKA
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHAVIKA
Other - Middle Name:RUTESH
Other - Last Name:DAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22100 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8431
Mailing Address - Country:US
Mailing Address - Phone:208-416-2932
Mailing Address - Fax:855-673-9190
Practice Address - Street 1:635 WENDOVER WAY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4192
Practice Address - Country:US
Practice Address - Phone:917-586-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012749662085R0202X
MS233102085R0202X
MS207332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00785631OtherRAILROAD MEDICARE
MSP01206953OtherRAILROAD MEDICARE
MS302I305847Medicare PIN
MSP01206953OtherRAILROAD MEDICARE
MS302I309854Medicare PIN