Provider Demographics
NPI:1013192582
Name:BANDETTINI, WIPHADA PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:WIPHADA
Middle Name:PATRICIA
Last Name:BANDETTINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WIPHADA
Other - Middle Name:PATRICIA
Other - Last Name:INGKANISORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NATIONAL INSTITUTES OF HEALTH BLDG 10, 10 CENTER DR
Mailing Address - Street 2:RM B1D-416
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-896-4007
Mailing Address - Fax:301-896-7521
Practice Address - Street 1:NATIONAL INSTITUTES OF HEALTH BLDG 10, 10 CENTER DR
Practice Address - Street 2:RM B1D-416
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-896-4007
Practice Address - Fax:301-896-7521
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057808207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease