Healthcare Provider Details

I. General information

NPI: 1053394130
Provider Name (Legal Business Name): RITU T BHAMBHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALTER WARD BLVD SUITE 300
ABINGDON MD
21009-1284
US

IV. Provider business mailing address

100 WALTER WARD BLVD SUITE 300
ABINGDON MD
21009-1284
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-8971
  • Fax: 877-595-7180
Mailing address:
  • Phone: 410-569-3333
  • Fax: 877-595-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0056138
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0056138
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: