MEDICARE: BISWA BHATTACHARYYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101042686	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080004014	OTHER	VA	PROVIDER TPAN
2	C02088	OTHER	VA	OCEANA TPAN

General Provider Information

NPI Number	:	1023099603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BISWA BHATTACHARYYA MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	2088 S INDEPENDENCE BLVD STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4790
Country	:	US
Telephone Number	:	757-275-9331
Fax Number	:	757-416-7656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/18/2019

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