MEDICARE: DR. SONYA NADINE BETHEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101041548	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1063466076	OTHER	BCBS-VA
2	350541	OTHER	ANTHEM BCBS
3	5374-0020	OTHER	BCBS OF DC
4	01-24040	OTHER	EVERCARE

General Provider Information

NPI Number	:	1063466076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONYA NADINE BETHEL M.D.

Provider Business Mailing Address
First Line	:	5525 RESEARCH PARK DR
Second Line	:	4TH FLOOR
City	:	BALTIMORE
State	:	MD
Zip	:	21228-4873
Country	:	US
Telephone Number	:	703-923-4644
Fax Number	:	703-923-4625

Provider Business Practice Location Address
First Line	:	7440 SPRING VILLAGE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-4446
Country	:	US
Telephone Number	:	703-923-4644
Fax Number	:	703-923-4625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/06/2015

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