Provider Demographics
NPI:1366867780
Name:ANBAZHAGAN, BHUVANESWARI
Entity Type:Individual
Prefix:
First Name:BHUVANESWARI
Middle Name:
Last Name:ANBAZHAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021B EMMORTON RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8980
Mailing Address - Country:US
Mailing Address - Phone:410-569-1001
Mailing Address - Fax:
Practice Address - Street 1:2021B EMMORTON RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8980
Practice Address - Country:US
Practice Address - Phone:410-569-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered