Provider Demographics
NPI:1609912351
Name:BHATTI, JAWAD W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAWAD
Middle Name:W
Last Name:BHATTI
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 1:14631 CHARTER WALK CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4694
Mailing Address - Country:US
Mailing Address - Phone:804-302-8571
Mailing Address - Fax:804-368-1122
Practice Address - Street 1:7025 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-302-8571
Practice Address - Fax:804-368-1122
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD026275207R00000X
VA0101243032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574830Medicaid
VA1609912351Medicaid
P00789362Medicare PIN
LA5B710Medicare PIN
P00704022Medicare PIN
I07630Medicare UPIN
VA002040V16Medicare PIN
VAVAA102087Medicare PIN
VA018517033Medicare PIN