Healthcare Provider Details

I. General information

NPI: 1598476541
Provider Name (Legal Business Name): BHAGAWATI TIWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SOUTHAVEN RD
ANNAPOLIS MD
21401-7122
US

IV. Provider business mailing address

8683 MANAHAN DR
ELLICOTT CITY MD
21043-5439
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-1300
  • Fax:
Mailing address:
  • Phone: 801-472-9859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: