Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | NA | NJ |
Y | 111NI0900X | Internist | NA | NJ |
NPI | 1003020975 |
---|---|
Provider Name | Sowjanya Bhagavatula |
First Address | Woodbridge, VA 22192-4644 |
Second Address | Woodbridge, VA 22192-4644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 03/06/2021 |