Basic Information
| Provider Information | |||||||||
| NPI: | 1700089174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHUSHAN | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 BARNSIDE PL | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208505630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439568989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8901 ROCKVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208895095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 49927 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | D72017 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 873457000 | 05 | MN | MEDICAID | P00427426 | 01 | MN | RAILROAD MEDICARE | OTHER |