Provider Demographics
NPI:1821686718
Name:RISAL BHANDARY, BIMU
Entity Type:Individual
Prefix:
First Name:BIMU
Middle Name:
Last Name:RISAL BHANDARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 CANDLELIGHT LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2768
Mailing Address - Country:US
Mailing Address - Phone:301-655-8062
Mailing Address - Fax:
Practice Address - Street 1:12321 MIDDLEBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1591
Practice Address - Country:US
Practice Address - Phone:301-428-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR181250Medicaid