Provider Demographics
NPI:1538166095
Name:BIDOT, RAMON (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:BIDOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 HAY BALE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6054
Mailing Address - Country:US
Mailing Address - Phone:518-331-8668
Mailing Address - Fax:518-842-7545
Practice Address - Street 1:5900 E VIRGINIA BEACH BLVD STE 21
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2499
Practice Address - Country:US
Practice Address - Phone:757-995-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206689-1207R00000X, 208000000X
VA0101278262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01752125Medicaid
NY01752125Medicaid
NYCC1862Medicare ID - Type Unspecified