Provider Demographics
NPI:1841295896
Name:BHAN, JASON MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MOHAN
Last Name:BHAN
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 1:25 BROAD ST APT 6I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2520
Mailing Address - Country:US
Mailing Address - Phone:703-945-2033
Mailing Address - Fax:
Practice Address - Street 1:46165 WESTLAKE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-444-3302
Practice Address - Fax:703-444-3240
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005647142Medicaid
001885M87Medicare ID - Type Unspecified