Provider Demographics
NPI:1790750453
Name:BHATNAGAR, MUKUL
Entity Type:Individual
Prefix:
First Name:MUKUL
Middle Name:
Last Name:BHATNAGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-2160
Mailing Address - Fax:571-231-6612
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273689207RC0000X
PAMD052764L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA060038526OtherRR MEDICARE
PA1019556OtherGATEWAY
PA204876OtherUPMC
PA609564700OtherUMWA
PA0014684600001Medicaid
PA232868515OtherUNITED HEALTHCARE
PA232868515OtherGEISINGER
PA45384OtherHEALTH AMERICA/ASSURANCE
PA544232OtherBLUE SHIELD
PA1019556OtherGATEWAY
PA0014684600001Medicaid