=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447464342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDER K. BHAT, M.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 S CARLIN SPRINGS RD SUITE #503
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-379-1661
-----------------------------------------------------
Fax | 703-379-1710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 S CARLIN SPRINGS RD SUITE #503
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-379-1661
-----------------------------------------------------
Fax | 703-379-1710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. INDER KRISHAN BHAT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 703-379-1661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 0101030753
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------