Healthcare Provider Details

I. General information

NPI: 1790850667
Provider Name (Legal Business Name): CHANDRAKANT K BHATIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD SUITE 610
CLINTON MD
20735-2508
US

IV. Provider business mailing address

9131 PISCATAWAY RD SUITE 610
CLINTON MD
20735-2508
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-2106
  • Fax: 301-868-6757
Mailing address:
  • Phone: 301-868-2106
  • Fax: 301-868-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0014824
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: