Provider Demographics
NPI:1629150586
Name:BAHETHI, BHAWNA (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAWNA
Middle Name:
Last Name:BAHETHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S
Mailing Address - Street 2:SUITE 501
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5577
Mailing Address - Country:US
Mailing Address - Phone:410-766-8911
Mailing Address - Fax:410-766-8977
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 501
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-766-8911
Practice Address - Fax:410-766-8977
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0051325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G65863Medicare UPIN