Healthcare Provider Details

I. General information

NPI: 1508903287
Provider Name (Legal Business Name): VIMLA BHOOSHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 LIVINGSTON RD
FORT WASHINGTON MD
20744-5151
US

IV. Provider business mailing address

9739 AVENEL FARM DR
POTOMAC MD
20854-5413
US

V. Phone/Fax

Practice location:
  • Phone: 301-203-2247
  • Fax: 301-203-2070
Mailing address:
  • Phone: 301-203-2247
  • Fax: 301-203-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIMLA BHOOSHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-203-2247