Healthcare Provider Details

I. General information

NPI: 1699938217
Provider Name (Legal Business Name): ANITA BAJAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 OLD COLUMBIA RD # L26D
COLUMBIA MD
21046-1703
US

IV. Provider business mailing address

10015 OLD COLUMBIA RD # L26D
COLUMBIA MD
21046-1703
US

V. Phone/Fax

Practice location:
  • Phone: 443-259-0400
  • Fax:
Mailing address:
  • Phone: 443-259-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA08321400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0068972
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: