Healthcare Provider Details

I. General information

NPI: 1366008344
Provider Name (Legal Business Name): NINA BHAGAT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

IV. Provider business mailing address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

V. Phone/Fax

Practice location:
  • Phone: 209-680-8626
  • Fax:
Mailing address:
  • Phone: 703-689-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102209566
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: