Healthcare Provider Details

I. General information

NPI: 1184886806
Provider Name (Legal Business Name): GAURAV BHATIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46090 LAKE CENTER PLAZA SUITE 102
STERLING VA
20165
US

IV. Provider business mailing address

46090 LAKE CENTER PLAZA SUITE 102
STERLING VA
20165
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-8583
  • Fax: 703-719-4935
Mailing address:
  • Phone: 703-719-8583
  • Fax: 703-719-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101253566
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101253566
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: