Healthcare Provider Details

I. General information

NPI: 1326131061
Provider Name (Legal Business Name): BHAVIN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/08/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax:
Mailing address:
  • Phone: 703-490-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0064801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: