Provider Demographics
NPI:1881787182
Name:PATHAK, BHAMA (MA CCCA)
Entity type:Individual
Prefix:
First Name:BHAMA
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-478-9898
Mailing Address - Fax:703-709-0826
Practice Address - Street 1:1800 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 315
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-478-9898
Practice Address - Fax:703-709-0826
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001347237600000X
VA2201000322231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter