Provider Demographics
NPI:1114923505
Name:BHATTI, NEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEENA
Middle Name:
Last Name:BHATTI
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 1:12101 OLD LINE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2552
Mailing Address - Country:US
Mailing Address - Phone:301-843-2223
Mailing Address - Fax:
Practice Address - Street 1:9450 MARLBORO PIKE
Practice Address - Street 2:STE 19
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2077
Practice Address - Country:US
Practice Address - Phone:301-599-5401
Practice Address - Fax:301-599-5401
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC68070001OtherBC/BS OF DC
MD388919OtherMAMSI HEALTH PLAN
MD4599345OtherCIGNA HEALTHCARE
MD499304OtherNCPPO
MD53282105OtherBC/BS OF MD
MDP00014305OtherRAILROAD MEDICARE
DC68070001OtherBC/BS OF DC
MDP00014305OtherRAILROAD MEDICARE