Provider Demographics
NPI:1598931339
Name:AMATYA, BIRENDRA M (MD)
Entity Type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:M
Last Name:AMATYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 GALLOWS ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-776-3582
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS ROAD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-776-3582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243021208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598931339Medicaid
VA1851572721OtherBC/BS OF VIRGINIA
WV3810015760Medicaid
VAP00657810Medicare PIN
VA00X836A03Medicare PIN