MEDICARE: DR. JASON MOHAN BHAN MD

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	0101232952	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841295896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MOHAN BHAN MD

Provider Business Mailing Address
First Line	:	25 BROAD ST APT 6I
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-2520
Country	:	US
Telephone Number	:	703-945-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	46165 WESTLAKE DR
Second Line	:	SUITE 120
City	:	STERLING
State	:	VA
Zip	:	20165
Country	:	US
Telephone Number	:	703-444-3302
Fax Number	:	703-444-3240

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/30/2018

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