Provider Demographics
NPI:1932289519
Name:BAHETHI, SHILPA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:P
Last Name:BAHETHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43512 STARGELL TER
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8468
Mailing Address - Country:US
Mailing Address - Phone:571-333-4771
Mailing Address - Fax:
Practice Address - Street 1:7475 WISCONSIN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3412
Practice Address - Country:US
Practice Address - Phone:301-986-8010
Practice Address - Fax:301-986-8011
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063626207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0063626OtherMD LICENSE