Healthcare Provider Details

I. General information

NPI: 1649437468
Provider Name (Legal Business Name): ERVIND SRIRAM BHOGTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD STE 210
PRINCE FREDERICK MD
20678-4040
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-9017
  • Fax: 443-771-8113
Mailing address:
  • Phone: 410-414-4791
  • Fax: 410-535-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD038703
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0073682
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD038703
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0073682
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: