Basic Information
Provider Information | |||||||||
NPI: | 1114923505 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BHATTI | ||||||||
FirstName: | NEENA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12101 OLD LINE CTR | ||||||||
Address2: |   | ||||||||
City: | WALDORF | ||||||||
State: | MD | ||||||||
PostalCode: | 206022552 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018432223 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9450 MARLBORO PIKE | ||||||||
Address2: | STE 19 | ||||||||
City: | UPPER MARLBORO | ||||||||
State: | MD | ||||||||
PostalCode: | 207722077 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3015995401 | ||||||||
FaxNumber: | 3015995401 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2005 | ||||||||
LastUpdateDate: | 03/19/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0046292 | MD | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 68070001 | 01 | DC | BC/BS OF DC | OTHER | 388919 | 01 | MD | MAMSI HEALTH PLAN | OTHER | 4599345 | 01 | MD | CIGNA HEALTHCARE | OTHER | 499304 | 01 | MD | NCPPO | OTHER | 53282105 | 01 | MD | BC/BS OF MD | OTHER | P00014305 | 01 | MD | RAILROAD MEDICARE | OTHER |