Healthcare Provider Details

I. General information

NPI: 1497842397
Provider Name (Legal Business Name): SAMEER BAJAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 WAVERLY DR APT 907
LOS ANGELES CA
90039-2788
US

IV. Provider business mailing address

2753 WAVERLY DR APT 907
LOS ANGELES CA
90039-2788
US

V. Phone/Fax

Practice location:
  • Phone: 646-796-8194
  • Fax:
Mailing address:
  • Phone: 646-796-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-087620
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA135341
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA135341
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA135341
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA135341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: