Provider Demographics
NPI:1437176302
Name:BHAVE, ANANT D (MD)
Entity type:Individual
Prefix:DR
First Name:ANANT
Middle Name:D
Last Name:BHAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:789 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9068
Mailing Address - Country:US
Mailing Address - Phone:802-847-3592
Mailing Address - Fax:802-847-4822
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3592
Practice Address - Fax:802-847-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-00102312085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008084Medicaid
VT1008084Medicaid
VTVN2666Medicare ID - Type Unspecified