Healthcare Provider Details

I. General information

NPI: 1790092922
Provider Name (Legal Business Name): PRITA BHARDWAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SUDLEY RD
MANASSAS VA
20110-4418
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax: 703-396-5297
Mailing address:
  • Phone: 703-396-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101248365
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101248365
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: