Provider Demographics
NPI:1609055722
Name:BHOWMIK MEDICAL PRACTICE
Entity Type:Organization
Organization Name:BHOWMIK MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIHAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:BHOWMIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-399-0701
Mailing Address - Street 1:301 GOODE WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-399-0701
Mailing Address - Fax:757-399-3731
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-399-0701
Practice Address - Fax:757-399-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22827OtherBCBS
C05686OtherMEDICARE PROVIDER
22827OtherBCBS