Healthcare Provider Details

I. General information

NPI: 1336318484
Provider Name (Legal Business Name): AMIT BAKRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FORBES PL
SPRINGFIELD VA
22151-2208
US

IV. Provider business mailing address

8001 FORBES PL
SPRINGFIELD VA
22151-2208
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101253584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: