Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0103300921 | VA |
NPI | 1326152976 |
---|---|
Provider Name | Dr. Mukesh D. Bhakta |
First Address | Leesburg, VA 20176-2704 |
Second Address | Gainesville, VA 20155-3089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 01/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81028 | (02) | VA |