Provider Demographics
NPI:1023099603
Name:BHATTACHARYYA, BISWA (MD)
Entity type:Individual
Prefix:
First Name:BISWA
Middle Name:
Last Name:BHATTACHARYYA
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2088 S INDEPENDENCE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4790
Practice Address - Country:US
Practice Address - Phone:757-275-9331
Practice Address - Fax:757-416-7656
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080004014OtherPROVIDER TPAN
VAC02088OtherOCEANA TPAN
VAC02088OtherOCEANA TPAN
VAC36576Medicare UPIN
VA080004014Medicare PIN