Provider Demographics
NPI:1063466076
Name:BETHEL, SONYA NADINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:NADINE
Last Name:BETHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:703-923-4644
Mailing Address - Fax:703-923-4625
Practice Address - Street 1:7440 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4446
Practice Address - Country:US
Practice Address - Phone:703-923-4644
Practice Address - Fax:703-923-4625
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063466076OtherBCBS-VA
350541OtherANTHEM BCBS
5374-0020OtherBCBS OF DC
01-24040OtherEVERCARE
01-24040OtherEVERCARE
5374-0020OtherBCBS OF DC
1063466076OtherBCBS-VA