Organization
CCMH SYED BHAT MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ED PITCHFORD (CEO)
(814) 274-5216
Entity
Organization
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-9300
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001524689
BLUE SHIELD PROVIDER NUMBER
PA
Enumeration date
05/08/2008
Last updated
05/08/2008
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