Healthcare Provider Details

I. General information

NPI: 1659534998
Provider Name (Legal Business Name): BHAVISHA MENEZES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BHAVISHA DIXIT M.D.

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 METRO CENTER DR
RESTON VA
20190-5286
US

IV. Provider business mailing address

11580 CEDAR CHASE RD
HERNDON VA
20170-2474
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-1500
  • Fax:
Mailing address:
  • Phone: 917-224-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0069205
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD038253
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101245812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: