Healthcare Provider Details

I. General information

NPI: 1962694125
Provider Name (Legal Business Name): GITANJALI RAJENDRAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT RD STE 3
BRANDYWINE MD
20613-3035
US

IV. Provider business mailing address

451 SWANN AVE APT 543
ALEXANDRIA VA
22301-1579
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17605
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22D102702701
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: