Healthcare Provider Details

I. General information

NPI: 1508164021
Provider Name (Legal Business Name): TAPAN MAHENDRA BHAVSAR MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 08/16/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GWMFA-MEDICAL FACULTY ASSOCIATES, INC 2150 PENNSYLVANIA AVE NW FL 10
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2131 K ST NW SUITE 450-CREDENTIALING
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-6615
  • Fax:
Mailing address:
  • Phone: 202-715-4479
  • Fax: 202-715-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD047421
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD047421
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: