Provider Demographics
NPI:1144320714
Name:BHATIA, MADHU (MD)
Entity type:Individual
Prefix:DR
First Name:MADHU
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 WESTPARK DR
Mailing Address - Street 2:STE 140
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3197
Mailing Address - Country:US
Mailing Address - Phone:703-404-2701
Mailing Address - Fax:703-404-2703
Practice Address - Street 1:6 PIDGEON HILL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6146
Practice Address - Country:US
Practice Address - Phone:703-404-2701
Practice Address - Fax:703-404-2703
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0367362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA71-0639-4Medicaid