Provider Demographics
NPI:1275601262
Name:PATNAIK, BELLA DAVE (MD)
Entity Type:Individual
Prefix:DR
First Name:BELLA
Middle Name:DAVE
Last Name:PATNAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8150 LEESBURG PIKE #909
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:703-790-1780
Mailing Address - Fax:703-734-0491
Practice Address - Street 1:8150 LEESBURG PIKE #909
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2714
Practice Address - Country:US
Practice Address - Phone:703-790-1780
Practice Address - Fax:703-734-0491
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6309593Medicaid
H33468Medicare UPIN
009635T98Medicare ID - Type Unspecified