Provider Demographics
NPI:1255515672
Name:PANKAJ K BHATNAGAR MD PC
Entity type:Organization
Organization Name:PANKAJ K BHATNAGAR MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHATNAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-791-7855
Mailing Address - Street 1:PO BOX 35197
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5197
Mailing Address - Country:US
Mailing Address - Phone:702-791-7855
Mailing Address - Fax:702-791-7859
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:STE 204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-791-7855
Practice Address - Fax:702-791-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417929175Medicaid
NVV105785OtherMEDICARE PTAN IND
NVV105784OtherMEDICARE PTAN GROUP
NVV105784OtherMEDICARE PTAN GROUP