=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114923505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEENA BHATTI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 03/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9450 MARLBORO PIKE STE 19
-----------------------------------------------------
City | UPPER MARLBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20772-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-599-5401
-----------------------------------------------------
Fax | 301-599-5401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12101 OLD LINE CTR
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-2552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-843-2223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | D0046292
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------