Healthcare Provider Details

I. General information

NPI: 1558649426
Provider Name (Legal Business Name): PRIYA BAJRACHARYA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 GEORGIA AVE
SILVER SPRING MD
20910-4519
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-4682
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC002476
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: