Basic Information
| Provider Information | |||||||||
| NPI: | 1902312358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIVARTHI | ||||||||
| FirstName: | BHARADWAJ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206502015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758981 | ||||||||
| FaxNumber: | 2404347007 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758981 | ||||||||
| FaxNumber: | 2404347007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 05/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D87045 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.