Provider Demographics
NPI:1902312358
Name:NIVARTHI, BHARADWAJ (MD)
Entity Type:Individual
Prefix:
First Name:BHARADWAJ
Middle Name:
Last Name:NIVARTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:301-475-8981
Mailing Address - Fax:240-434-7007
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-8981
Practice Address - Fax:240-434-7007
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD87045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine