Provider Demographics
NPI:1003867607
Name:BHASKARABHATLA, KAUSALYA CHENNAPRAGADA (MD)
Entity type:Individual
Prefix:DR
First Name:KAUSALYA
Middle Name:CHENNAPRAGADA
Last Name:BHASKARABHATLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAUSALYA
Other - Middle Name:
Other - Last Name:CHENNAPRAGADA BHASKARABHATLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4501 SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8687
Mailing Address - Country:US
Mailing Address - Phone:925-813-6500
Mailing Address - Fax:
Practice Address - Street 1:4501 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8687
Practice Address - Country:US
Practice Address - Phone:925-813-6500
Practice Address - Fax:973-200-0120
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC197174207R00000X
NJMAO71431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53175Medicare UPIN